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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.
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:
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.
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:
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:
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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