Physical Examination - Diagnosis of erectile dysfunction

Erectile dysfunction (ED) has been defined as the persistent inability to achieve and/or to maintain an erection for a satisfactory sexual intercourse. This event can occur occasionally without inducing psychological or managerial problems, but frequent ED can lead to emotional and relational disorders which can often reduce self-esteem, reinforcing dysfunctional processes.

ED represents a very important public health problem and can strongly compromise both the patient and the couple’s quality of life because of a combined presence of organic and psychological aspects and frequent correlation with clinical comorbidities.

Diagnosis of erectile dysfunction does not require complicated tests. After taking a history of sexual function and general medical factors, the doctor will do a physical examination of the penis, testes and prostate. Blood tests are done to check glucose (sugar levels), cholesterol and testosterone levels.

Physical examination in erectile dysfunction should involve careful assessment of the external genitalia to detect the presence of cutaneous penile lesions, a Peyronie’s plaque or testicular abnormalities (Figures 39, 40, 41, 42, 43,

44). Rectal examination should be performed to exclude benign prostatic hyperplasia or induration/nodularity suggestive of prostatic cancer. A focused neurological evaluation, including assessment of anal sphincter tone, should be performed and peripheral pulses palpated to detect signs of vascular disease. The distribution of body hair may provide a clue to androgen status. Blood pressure should be recorded with the patient both standing and lying down, and the presence or absence of obesity and/or gynecomastia noted.

The abdomen should be palpated to exclude aortic aneurysm.

Table III Quality of life and erectile dysfunction

1. I feel frustrated because of my erection problem
2. My erection problem makes me feel depressed
3. I feel like less of a man because of my erection problem
4. I have lost confidence in my sexual ability
5. I worry that I won’t be able to get or keep an erection
6. My erection problem is always on my mind
7. I feel that I have lost control over my erections
8. I blame myself for my erection problem
9. I feel angry because of my erection problem
10. I worry about the future of my sex life
11. I have lost pleasure in sex because of my erection problem
12. I am embarrassed about my problem
13. I worry about being humiliated because of my problem
14. I try to avoid having sex
15. I feel different from other men because of my erection problem
16. I get less enjoyment out of life because of my erection problem
17. I feel guilty about my erection problem
18. I am afraid to ‘make the first move’ towards sex
19. I worry that my partner blames herself for my erection problem
20. I worry about letting her down because of my erection problem
21. I worry that I’m not satisfying her because of my erection problem
22. I worry that we are growing apart because of my erection problem
23. I worry that she is looking for someone else because of my erection problem
24. I feel that she blames me for my erection problem
25. I worry that she thinks I don’t want her because of my erection problem
26. I have trouble talking to her about my erection problem
27. My erection problem interferes with my daily activities
Reproduced with permission from Wagner et al., 1996

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