The diagnosis of erectile dysfunction requires experience and specialized knowledge, since many times the causes are mixed and therefore treatment should be targeted.
Must be taking full medical, urologic and andrology history. In general history, should be asked the man for concomitant diseases (eg diabetes, hypertension, hypercholesterolemia, etc.), for taking drugs for other diseases, for alcohol and cigarettes and drugs, for any pelvic surgery, spine and / or the brain, for application of radiotherapy or chemotherapy, for wounds in the past and for the coexistence of neurological or psychiatric disorders. In urological history emphasized possible UTI / prostatitis possibly overstretched or pester our patient as well as any disease of the testes and penis. Regarding the history of Andrology, specify the start time of the problem and how it occurred (gradually or suddenly), the presence or absence of premature ejaculation as well as possible treatments have so far.
Involves checking the penis and testicles (size, shape, composition) and prostate gland with digital rectal examination (if and when necessary). The penis should be examined in erection and relaxation for any deformities or fiber bending it. Must also consider a broad neurological assessment and control of waist circumference (obese patients) and control for concurrent gynecomastia, acromegaly and exophthalmos, signs indicating hormonal disorder.
According to the European Urological Association exams required for the investigation of erectile dysfunction are classified as follows:
• blood Sugar
• Serum testosterone
• T3, T4, TSH
• Investigation of nocturnal erections (Rigiscan)
• Color Doppler of the arteries of the penis and
• Pharmaco – sirangografia
Specific diagnostic tests in patients with erectile dysfunction, should definitely be performed in the following cases:
1. Patients with Primary Factor
2. In people with a history of pelvic or perineal trauma who are candidates for revascularisation
3. Patients with anatomical abnormalities of the penis that can be addressed surgically
4. Patients with complex psychiatric or psychosexual disorders
5. Patients with complex endocrinopathies
6. Upon the patient’s wishes
7. For legal reasons (before placement of penile prosthesis, sexual abuse etc).
If the discrepancy is detected above the normal range, control supplemented with other tests such as prostate ultrasound , CT or MRI etc.
It is worth noting that in recent years the emphasis given to the relationship between erectile dysfunction and cardiac disease. So it is now accepted that the ED may precede or be the consequence of cardiovascular damage and for this reason most consider REQUIRED CARDIOLOGICAL CONTROL investigating men with problems.