Synonyms
Erectile dysfunction, potency problems, impotence, medical: Erectile Dysfunction (ED)The diagnosis of erectile dysfunction involves several steps. It is usually diagnosed by a urologist, who is the responsible specialist. Anamnesis: During a consultation, the doctor asks about the patient’s symptoms, their severity and their possible dependence on certain situations or factors.
In this way it can be clarified whether erectile dysfunction occurs in relation to the partner, whether it also exists at night while sleeping, or whether there are other psychological causes. In addition, the urologist gets a picture of any previous illnesses, operations and risk factors that could lead to erectile dysfunction (diabetes, vascular diseases, smoking behaviour, medication, prostate cancer etc). This conversation is usually difficult and not pleasant for a man, as erectile dysfunction is a very personal and socially taboo subject.
However, it is one of the most important components to ensure a good diagnosis. Clinical examination: The doctor now physically examines the patient for any visible changes in the penis or testicles, which may reveal injuries or malformations. Furthermore, he palpates the prostate via the wall of the anus for enlargements or changes in shape.
A test of the so-called bulbospongiosus reflex (anal reflex, perineal reflex), as well as the cremasteric reflex (testicle elevator reflex) provides information about the proper function of the nerve tracts and the important spinal cord segments. Laboratory diagnostics: These tests allow certain parameters in the blood to be determined, which allow a statement to be made about the condition of the blood vessels and the concentration of hormones in the body. This enables the doctor to narrow down or exclude the various causes of erectile dysfunction.
The following values are determined: Fasting – blood sugar, blood fat values, testosterone, SHBG (steroid hormone binding globulin). Specific clinical tests: Depending on the issue at hand, various test procedures can now be carried out to examine the erectile tissue and penile vessels more closely. Cavernous body pharmaceutical test (SKAT test): It is now considered the standard test in the diagnosis of erectile dysfunction.
A vasoactive (vascular influencing) drug is injected with a thin needle sideways into the erectile tissue. Prostaglandin 1 is usually used for this purpose, either alone or in combination with other vasodilating substances (papaverine, phentolamine). Due to the anatomically given connection of the three corpora cavernosa among each other, the substance distributes itself there by itself.
Doppler sonography: This test is usually combined with the SKAT test. Approximately 10 minutes after the application of the vasoactive substance into the erectile tissue, the arteries of the penis responsible for blood filling are assessed with an ultrasound probe (see ultrasound). The Doppler function at the ultrasound probe can represent the pulsating blood flow as a sound, which provides information about the expandability of the vessel width, especially in the first phases of erection.
Duplex sonography: It is similar to Doppler sonography, but with the additional option of showing the arteries in cross-section. Nocturnal penile tumescence measurement (NPT): This test offers an additional option for detecting changes in nocturnal erection frequency and quality. 4 – 6 erections with an average duration of approximately 30 minutes per night are considered normal.
The measurement is performed in the sleep laboratory or at home with a device designed for this purpose (e.g. RigiScan). This method can substantiate the suspicion of a psychologically caused erectile dysfunction, since the nightly erections are performed on a purely physical level, to the exclusion of consciousness.