When you visit a doctor to ask about erectile dysfunction, also known as ED or impotence, you should try not to be embarrassed. Erectile dysfunction is common, affecting one in 5 Australian men older than 40 years.
Having problems with erections is not a reflection of your manhood — erectile dysfunction is a medical condition and your doctor will treat it as such.
To evaluate erection problems, your doctor will usually take a medical history (ask questions about your current and past health) and conduct a physical examination to look for any underlying conditions that could be causing your erectile dysfunction.
Erectile dysfunction can be an early warning sign that you are at increased risk of cardiovascular disease (which causes angina and heart attack). Your doctor will be able to assess the cause of your erectile dysfunction and discuss whether you are at increased risk of heart disease.
What happens when you see a doctor about erectile dysfunction?
As part of the consultation, your doctor may:
- ask detailed questions about the nature of your erectile difficulties, including whether you have problems with erections in all situations or just sometimes, whether you have morning erections, whether your level of sexual desire has changed, and how long you have had these problems;
- ask you questions about medical conditions that affect you or your family, including diabetes, high blood pressure, heart disease, stroke or vascular (blood vessel) disease, obesity, anxiety, depression, or Peyronie’s disease (in which hardened tissue causes the penis to curve at an unusual angle);
- ask if you have had surgery or injuries to the pelvic area;
- ask if you have had problems with your prostate;
- ask about any medicines that you are taking, including complementary medicines;
- ask about your lifestyle, such as how much alcohol you drink, whether or not you smoke, whether you take illicit drugs, how much physical activity you get and how stressed you may be; and
- ask about your sexual and emotional health, and may ask about your relationship with your partner. Talk to your doctor if you are concerned about the impact of erectile dysfunction on your relationship or future relationships.
Your doctor will also perform a physical examination, and depending on your age and medical history, may perform some or all of the following:
- check your weight, waist circumference and body mass index (BMI);
- check your blood pressure and blood flow in your legs;
- examine your genitals (penis and testes); and
- conduct a rectal examination to check for an enlarged prostate.
Tests and investigations for erectile dysfunction
Depending on the information you provide, your doctor may order some tests or investigations. Possible tests for erectile dysfunction include the following.
- Blood tests to measure your cholesterol level, blood glucose (sugar) level, certain hormones (such as testosterone and thyroid hormone levels), full blood count and liver and kidney function tests.
- Urine tests to check for signs of diabetes and other health problems.
- Nocturnal (overnight) erection test. Most men have several erections while they sleep overnight, which they don’t remember. A test may be recommended to measure whether you have erections while you are asleep. This involves wearing a special monitoring device, and can be done at home or in a specialised sleep lab. This test can help determine whether your impotence may be due to a physical or psychological problem – if the test does not record erections overnight, then the cause is more likely to be physical.
- A special ultrasound test called a Doppler ultrasound may be recommended to measure the level of blood flow through the penis and to image the erectile tissue in the penis. Sometimes this test is done before and after giving a medicine that may help produce an erection.
Diagnosing erectile dysfunction and its cause
Based on your history, examination findings and test results, your doctor will make a diagnosis and make suggestions for treatment to help manage your erectile dysfunction and any underlying conditions you may have.
Some men will be referred to a urologist (specialist in conditions affecting the male reproductive system and urinary tract), an endocrinologist (specialist in hormone problems) or a psychologist or sex therapist.
Remember, erectile dysfunction is a common problem that can often be successfully treated.