Diagnosis of erectile dysfunction

The proper goal-oriented evaluation of a man proactive and complaining of erectile dysfunction requires a sympathetically elicited history, a focused physical examination and various carefully selected special investigations.

HISTORY
To obtain a clear history, it is important that the patient himself understands the distinction between loss of libido, erectile dysfunction and ejaculatory disturbance. This often may require some preliminary explanation. The onset, consistency and severity of the complaint need to be established. Recently, the development of self-administered symptom scores by O'Leary and colleagues and Rosen and colleagues have facilitated quantitative history-taking for erectile dysfunction.

Because sexual function is intimately related to the appropriate response of the sexual partner, tactful enquiries need to be made concerning previous and on-going relationships, and the attitude of the partner towards the problem.

Underlying relationship problems are a common cause of erectile dysfunction, and this possibility needs to be tactfully explored in all cases. Although, by tradition, the question concerning the presence or absence of early morning erections has been proposed as a means to distinguish between psychogenic and organic erectile dysfunction, the value of this enquiry has recently been questioned.

Diagnosis of erectile dysfunction History Physical Examination Special Investigations

Many normal individuals do not regularly wake up with early morning erections, although the presence of a positive history of a firm erection on waking would make organic erectile dysfunction less likely. Although these symptom scores are admirable in their own way, they in fact tend to focus on the functional component of erectile dysfunction rather than its impact on the quality of life of the sufferer. This issue has recently been addressed by Wagner and colleagues, who have attempted to quantify the impact of erectile dysfunction on the sufferer (Table III).

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 erections8. I blame myself for my erection problem9. I feel angry because of my erection problem10. I worry about the future of my sex life11. I have lost pleasure in sex because of my erection problem12. I am embarrassed about my problem13. I worry about being humiliated because of my problem14. I try to avoid having sex15. I feel different from other men because of my erection problem16. I get less enjoyment out of life because of my erection problem17. I feel guilty about my erection problem18. I am afraid to ‘make the first move’ towards sex19. I worry that my partner blames herself for my erection problem20. I worry about letting her down because of my erection problem21. I worry that I’m not satisfying her because of my erection problem22. I worry that we are growing apart because of my erection problem23. I worry that she is looking for someone else because of my erection problem24. I feel that she blames me for my erection problem25. I worry that she thinks I don’t want her because of my erection problem26. I have trouble talking to her about my erection problem27. My erection problem interferes with my daily activities