Sexual Dysfunction – Diagnosis

How is sexual or erectile dysfunction diagnosed?

Diagnostic approaches for Sexual Dysfunction 

The first step is to visit a urologist, so that the doctor can evaluate the potential cause which is truly behind the erectile dysfunction (i.e. often not the obvious reasons), as well as estimate the stage (e.g. early, advanced etc.) of the erectile dysfunction itself. The laboratory investigation for erectile dysfunction (ED) depends on information gathered during the interview with the doctor.

Laboratory testing is necessary for most patients, but not for all. Image-based tests should always be performed, especially when we suspect conditions which typically have a significant impact in erectile dysfunction such as chronic prostatitis / chronic pelvic pain syndrome.

In this page, we will show all the necessary diagnostic tools that are commonly used for the diagnosis of sexual dysfunction.

Physical Examination for erectile & sexual dysfunction

To diagnose erectile dysfunction, your doctor will ask you questions about your symptoms and medical history. The doctor will conduct a complete physical exam, which will also include prostate feeling, to uncover signs such as poor circulation or nerve problems.

Through this examination, the doctor will also look for diseases such as chronic inflammatory prostate issues and for abnormalities of the genital area that could cause problems with erections (e.g. penile curvature or Peyronie’s disease).

This is typically the stage, where the doctor will ask the patient questions about the patient having:

  • waning or weakening morning erections
  • erectile longevity / endurance
  • premature ejaculation
  • penile softness or limited hardness during erection
  • burning in urination
  • frequency in urination
  • pains in the pelvic area
  • testicular pain
  • burning during or after ejaculation
  • decreased libido

Lab Tests for erectile & sexual dysfunction

A. Hormonal blood tests

Patients who suffer from decreased libido or signs that indicate hormonal imbalances (e.g. body hair loss, breast enlargement, increased fat, decreased muscle mass and strength) should undergo an endocrine evaluation.

This should consist of measuring total testosterone as well as the free testosterone levels. The latter one is the part of testosterone in the body that is actually doing the work on the tissue.

In case of low testosterone levels, measurement of luteinizing hormone (LH) may be helpful:

  • A high LH level associated with a low testosterone level implies primary testicular (Leydig cell) failure.
  • A low LH level associated with a low testosterone level suggests a central defect.

In some instances, prolactin levels may be helpful as well, especially if low serum testosterone levels have been documented. A serum thyroid-stimulating hormone (TSH) evaluation is appropriate in selected patients who have thyroid problem history.

B. Additional blood tests

Additional useful screening studies include the following:

  • Serum chemistry panel (blood cell counts, blood sugar levels, cholesterol levels, and liver function tests)
  • Lipid profile (HDL, LDL, etc.)

Measurement of the prostate-specific antigen (PSA) levels may be appropriate if the patient is a candidate for chronic inflammatory prostate issues and/or cancer screening.

C. Urinalysis

Performing a urinalysis is recommended to all patients. The presence of:

  • red blood cells
  • white blood cells
  • protein
  • glucose

can be important clues to a genitourinary disorder.

D. Prostate fluid & sperm culture

This is a critically important examination to confirm the potential cause of erectile dysfunction, which may be a chronic urogenital infection. The way to get the most accurate microbiological results, would be to collect prostate fluid through a rigorous and thorough digital rectal prostate massage prior to the examination. Failure to do so, may lead to misleading results (which is unfortunately a very common mistake that doctors make).

In addition, the patient must not have taken any antibiotics for at least 20 days prior to the examination, and should have not ejaculated for at least 3 days prior to giving samples for the tests.

Ultrasound examination for erectile & sexual dysfunction

A. Duplex Penile Ultrasonography

The blood flow within the penis can be evaluated by means of duplex ultrasonography. In this procedure, blood flow in the penile arteries is measured before and after the intracavernosal injection, which contains a dose of a standard vasodilator (e.g. 5 to 20 µg of PGE1).

Based on the results of the duplex, we can determine things such as:

  • arterial insufficiencies
  • venous leakage abnormalities (i.e. abnormal blood loss from the penis during erection)

B. Kindey & bladder ultrasound

An ultrasound examination of the kidneys and bladder provides insight into any possible complications. In many cases, kidney stones are typically formed as a result of poor quality of urination caused by problems in the prostate. The problem in the prostate could be indicative of an inflammation that could be the root cause of the erectile or sexual dysfunction.

C. Testicular ultrasound

Testicular ultrasonography in both testicles checks for any spread of the infection, while also providing information on the epididymitis and scrotal sac.

D. Penis ultrasound

The penile ultrasound examination is mainly used to highlight and measure a possible hard fibrotic lesion in the penile shaft, known as Peyronie disease.

E. Transrectal ultrasonography

A transrectal ultrasonography (TRUS) of the prostate provides the most thorough possible picture of any inflammatory changes in the prostate. It measures the:

  • echogenicity of the tissue (which shows how inflammed the tissue is at different areas)
  • vasculature at the damaged areas (which indicates intense inflammation)
  • calcifications in the prostate
  • size of the gland

The transrectal ultrasound is also used to estimate the presence of the inflammation in the seminal vesicles (if it has spread), spot possible dilatation of the utricle cyst, and find calculi of the ejaculatory ducts.

Urine flow evaluation for erectile & sexual dysfunction

A. Uroflowmetry

The uroflowmetric control provides important information on the quality of urination such as strength, quantity, duration and volume.

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