How is ED diagnosed?
Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.
Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.
The history should include the frequency and duration of symptoms, the presence or absence of morning erections and the quality of the relationship with the sexual partner. The sudden onset of erectile dysfunction in association with normal morning erections or a poor relationship suggests psychogenic impotence.
A detailed medical history may reveal that the disorder is due to a chronic disease such as atherosclerosis, hypertension or diabetes mellitus. Inquiry about decreased libido and symptoms of hypothyroidism or hyperthyroidism may reveal a reversible cause
Because as many as 25 percent of cases of erectile dysfunction are due to medication side effects the patient's drug therapy should be reviewed. Common pharmacologic causes of this disorder include antihypertensive drugs, most notably the centrally acting agents, beta blockers and diuretics. Antipsychotic and antidepressant drugs are also frequently implicated. Other drugs that can cause erectile dysfunction include spironolactone (Aldactone), cimetidine (Tagamet) and finasteride (Proscar).
Excessive alcohol intake, heroin use and cigarette smoking are also known causes
A thorough history is the most important factor in the evaluation of the patient with erectile dysfunction. The initial step is to identify the patient's concern with his sexual function. Several studies have indicated that patients and providers are reluctant to address sexual topics. Physicians cite not knowing what questions to ask or how to ask them, feeling uncomfortable with the topic, awkwardness with sex language and fears of insulting the patient as reasons for their reluctance. However, evidence suggests that the vast majority of patients believe sexual function is an appropriate topic to be raised by their physician and are relieved when these topics are addressed
Sexual function can often be incorporated in the discussion when reviewing the effects of a patient's chronic medical problems or medication use. An effective technique in this setting is to ask "inform-then-probe" type questions. First, provide information about conditions that are commonly associated with sexual dysfunction, then follow with a question about the individual's concerns. For example, you could say "Many men (insert a condition that affects the particular patient, such as diabetes, hypertension, medication, recent heart attack, etc.) experience sexual problems. Has this happened to you?" This approach further educates the patient and reassures him that his symptoms are common.
