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Erectile dysfunction (ED) means that a man has difficulty getting and keeping an erection. There are a number of causes of erectile dysfunction, both physical and psychological, which means that there are a variety of tests that can help diagnose ED. Once the cause of erection problems is established, the right treatment can begin.

How is ED diagnosed?

If you think that you might have erectile dysfunction, the first step is to consult your GP or visit your local genitourinary medicine (GUM) clinic. They will look at your medical history and ask you questions about your sexual activity past and present. It can feel a bit uncomfortable to be asked questions about your sex life, but answering honestly will help your doctor to determine if you need further investigations for erectile dysfunction. You can ask for a male doctor if that makes you feel more comfortable.

The questions will cover both your physical and emotional health and might include:

  • Are you a smoker?
  • How much do you drink?
  • How much exercise do you take?
  • What drugs are you currently taking (both prescription and recreational)?
  • When did you first start experiencing symptoms of ED?
  • Have you had an injury to your penis?
  • Are you under stress at work or at home?
  • Are you depressed?
  • Do you have anxiety?

You will also be asked about your sex life and your sexual history. This could include questions about your current and past sexual partners, your sexual orientation, your sex drive (libido), under what circumstances you are able to get an erection (with your partner at all or on your own), if you have an erection first thing in the morning, and whether you are able to ejaculate or orgasm.

If you are unable to get an erection under any circumstances then there could be a physical cause for your symptoms. If you only experience symptoms of ED when trying to have sexual intercourse, the problem may be psychological.

Certain conditions, such as cardiovascular disease or diabetes, may contribute to erection problems and may need to be treated first. Treating the underlying cause of erectile problems can sometimes solve the problem.

Your GP might take your blood pressure, listen to your heart, weigh you and take height and waist circumference measurements, and carry out blood and urine tests. These tests will help to determine if you are suffering from any physical conditions that may be restricting blood flow. A narrowing of blood vessels due to certain health conditions can cause ED as the blood flow to the penis is reduced.

The doctor or GUM nurse may then carry out a physical examination of your penis to rule out any structural problems in your penis that may be affecting the blood supply to your penis. A condition known as Peyronie’s disease caused by hardened scar tissue in the penis can contribute to ED.

What is an erectile dysfunction test?

If your doctor or GUM nurse thinks that you may have erectile dysfunction due to underlying health conditions, they might carry out further tests.

These tests can include:

  • Complete blood count test: this can test for a number of things, including anaemia. Anaemia can cause fatigue (extreme tiredness), which can contribute to erection problems.
  • Blood glucose: this tests the level of sugar in your blood and can show if you have diabetes which can contribute to erectile dysfunction.
  • Lipid test: lipids are fats, and if you have higher levels it may mean that you have high cholesterol which may mean that you have a condition which hardens the arteries (atherosclerosis). Hardening of the arteries can have an effect on blood flow to the penis, causing erection problems.
  • Liver and kidney function tests.
  • Blood hormone tests: these measure levels of the male sex hormone testosterone in the blood. If the level is too low, your doctor may recommend further tests to rule out hormonal conditions that can be a factor in ED.
  • Urine tests: testing your urine for sugar, protein and testosterone levels can help to identify further underlying health conditions that may contribute to. erectile problems.

If necessary, your doctor or GUM nurse may refer you to a urologist, a specialist who will carry out other diagnostic tests to help them to diagnose the problem and devise the best treatment plan for you. If they think that the problem may be down to psychological causes they may refer you for psychological assessment and treatment such as sexual counselling.

Further erectile dysfunction tests may include:

  • An intracavernous injection test: this involves injecting a synthetic hormone into your penis which increases blood flow and helps to determine if you have problems with the blood flow to your penis. This is followed by an ultrasound scan which images the tissues and blood vessels in the penis to see if they are narrowed or ‘leaky’.
  • The nocturnal penile tumescence (NPT) test: this shows if you are experiencing erections during sleep. One method is to place elastic bands around the tip and base of the penis. If they snap during the night, erections are occurring. If not, a physical problem or a side effect of medication that restricts blood flow to the penis or blocks the nerve messengers that trigger erections may be to blame.
  • Arteriography and dynamic infusion cavernosometry or cavernosography: a special dye is injected into the blood vessels of the penis. The dye shows up on a scanner and lets the doctor see how the blood vessels are working.


Is there a link between erectile dysfunction and testosterone?

Testosterone is the male sex hormone that is responsible for male sexual response, amongst other things. If testosterone levels are low, it can cause a lowering in your desire for sex and erectile problems. Having ED doesn’t automatically mean, however, that you have low testosterone. Similarly, prescribing testosterone replacement therapy doesn’t always mean that erectile problems will get better.

If you are experiencing symptoms of ED and other tests are inconclusive, a blood test to measure the level of testosterone in your blood may be recommended by your doctor. Testosterone levels vary at different times so you may need two tests. If you do have low testosterone levels, coupled with other symptoms including low libido and fatigue, the test will check for hormonal conditions such as hypogonadism. This condition means that you have an abnormally low level of testosterone, which may be a factor in erectile dysfunction.

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