Diagnosis

Diagnosis

The doctor typically interviews the patient about many physical and psychological factors.

Medical and Personal History. The doctor should take a medical and personal history and may ask about the following:

• Past and present medical problems
• Medications or drugs being used
• Any history of psychological problems, including stress, anxiety, or depression

Sexual History. In addition the doctor will ask about the patient's sexual history, which may include:

• The nature of the onset of the dysfunction
• The frequency, quality, and duration of any erections, and whether they occur at night or in the morning
• The specific circumstances when erectile dysfunction occurred
• Details of technique
• The patient's motivation for and expectations of treatment
• Whether problems exist in the current relationship

Interviewing the Sexual Partner. If appropriate, the doctor might also interview the sexual partner. In fact, including the partner in the counseling process is proving to be an important component in making the best treatment choices.

Physical Examination

The doctor should perform a careful physical exam, including examination of the genital area and a digital rectal examination (the doctor inserts a gloved and lubricated finger into the patient's rectum) to check for prostate abnormalities.

Trials Using Treatments for Erectile Function

A useful approach is to administer a treatment for erectile dysfunction and then observe the response. Doctors now usually recommend a trial of sildenafil (Viagra) to test for an erection response after 30 to 60 minutes. This drug is replacing more invasive and expensive tests, such as an injection of papaverine or prostaglandin E1, medications that dilate blood vessels in the penis. They produce an erection in about 15 minutes.

After administering the treatment and waiting the appropriate amount of time, the doctor then observes the erectile response, curvature of the penis, and response after erection, sometimes using an ultrasound scanner to assess blood flow.