Erectile dysfunction is defined as an inability to maintain an erection sufficient to have a satisfactory sexual intercourse. First of all doctor should differentiate between erectile dysfunction and other disorders in the field of sexuality. For a positive diagnosis of erectile dysfunction problems in achieving erections must be installed at least 3 months and be persistent, at all patient attempts.
Perhaps for many patients diagnostic evaluation seems complicated and difficult. Diagnostic does not require sophisticated investigations; it is primarily clinical. But this process cannot start without the patient recognizing he has a problem. This recognition it is best to be made in full agreement with his sexual partner. Sexuality is determined by many factors such as economic, cultural, religious, emotional, and deviations from normal can occur easily. Best therapeutic solutions are obtained when the patient is very motivated and has a much trained medical specialist.
Clinical examination begins with medical history; the first step in diagnosis. Medical history highlights the personal pathology the patient may inherit and can determine the nature of erectile dysfunction. The history of sexual activity helps the doctor to distinguish among erectile dysfunction and other sexual problems (libido, ejaculation, orgasm, pain syndromes).
Dialogue should be decent, without negative connotations. The smallest details can highlight the problem. Psychosocial elements should not be left out, sometimes non-disclose tendencies (depression, lack of communication in the couple, anxiety) can block the doctor- patient communication and can lead to a wrong diagnosis. To facilitate communication with the patient, experts have created a series of self-assessment scale. The results of these assessments can be a starting point in the clinical evaluation. These are very useful when the open medical dialog failed. Depending on the patient motivation and the assessments scores, doctor can give a diagnosis and implicitly a treatment.
Medical history will be followed by general clinical examination that focuses on genitourinary and perineal areas, including measuring BP and heart rate. Several laboratory tests can be made to clarify the etiological aspects suggested by the data obtained in the first phase. In these situations doctor can recommend tests for plasma glucose, glycosylated hemoglobin (HbA1c) and lipid profile to detect diabetes. Sometimes, doctors recommend exploring the hypothalamic-pituitary-testicular testosterone levels in order to determine the cases of low libido or reduced testicular size. Optional tests include the determination of LH, prolactin, TSH, complete blood count, urinalysis.
In order to rule out psychological causes of erectile dysfunction the patient is ask to monitor erections that occur during sleep. The prolonged absences of nocturnal erections exclude psychological cause of erectile dysfunction.