Erectile Dysfunction: Diagnostics and Treatment

Erectile Dysfunction Diagnostics

Erectile dysfunction diagnostics is based on:

• anamnesis;
• examination;
• instrumental and laboratory examination.

1. Information collection facilitates the use of adapted questionnaires. The use of such forms makes it possible not only to smooth out a feeling of embarrassment in conversation with a shy patient but also to save doctor’s time.
2. Laboratory diagnosis includes: determination of male hormonal status, according to testimony, analyzes that exclude or confirm the presence of somatic diseases (blood glucose, PSA, lipid spectrum, total cholesterol, HDL, LDL, general blood test, general urine analysis.) are prescribed.
3. In some cases, monitoring of nocturnal spontaneous erection is used. This method allows differential diagnosis of organic and psychogenic forms. So, with psychogenic ED, unlike organic, spontaneous nocturnal erection are preserved.
4. Ultrasonic dopplerography (USDG) of penile arteries allows evaluating microcirculation, to reveal structural changes in cavernous fibrosis and Peyronie’s disease. USDG penile arteries are more informative if it is performed in the state of rest and erection followed by the comparison of results.
5. The test with the intracavernous introduction of vasoactive drugs (usually – alprostadil, the analog of prostaglandin E) allows revealing vasculogenic ED. With normal arterial and venous-occlusive hemodynamics 10 minutes after injection there is expressed erection that persists for 30 minutes or more.

Other Erectile Dysfunction Indications

• Cavernosometry (determination of physiological solution volumetric velocity injected into cavernous bodies necessary for erection onset) is the main test directly assessing the degree of disturbance of sinusoidal system elasticity and its closing ability;
• Cavernosography (demonstrates venous vessels, through which blood shunt from cavernous bodies predominantly takes place);
• Radioisotopic phalloscintigraphy (allows to estimate qualitative and quantitative indices of regional hemodynamics in penile cavernous bodies);
• Neurophysiological studies, in particular, the definition of bulbocavernosus reflex in patients with diabetes mellitus, with spinal cord damage.

Erectile Dysfunction Treatment

Conservative ED treatment methods are determined by the doctor:

1. inhibitors of phosphodiesterase type 5 (Viagra, Levitra, Cialis). Contraindication for Viagra, Cialis, Levitra appointment is drugs reception with nitric oxide or nitrate donors in any dosage form (Nitrosorbide, nitroglycerin and etc.).
2. hormonal replacement therapy. If the disease is caused by hormonal disorders, it is necessary to restore normal hormonal status. To date, there are convenient dosage forms that allow you to adjust testosterone level (male sex hormone): Androgel, Nebido.
3. another method of treatment is vacuum therapy using a pump for penis. A vacuum device is arranged quite simply – it consists of a tube, which is connected to a pump. You put penis in the tube and pump out the air from the tube. As a result, vacuum forms, which stimulates blood flow to the penis.
4. if erectile dysfunction treatment is not successful, or if a patient can not for any reason take PDE5 inhibitors or use a vacuum device, you may use Alprostadil. Alprostadil helps to improve blood flow to the penis. Alprostadil injection can be done directly into the penis or a small pill (urethral tube) can be placed in the urethra.
5. psychotherapy (sex therapy). If ED cause lies in the field of psychology, you need psychotherapist assistance. Sex therapy is a form of psychotherapy when you and your partner can discuss any issues related to sexual life, emotional problems that can contribute to disease’s development. The therapist can also provide you with practical recommendations on issues such as ways of erotic stimulation before sexual intercourse and advise what other effective treatments can be used to improve your sex life.
6. cognitive behavioral therapy is another type of psychological counseling that can be useful in erectile dysfunction. The basis of this method is the following principle: what we feel depends to a large extent on how we think about it. Consequently, harmful thoughts and unrealistic views can seriously affect your self-esteem, sexuality, and your relationships with loved ones and contribute to erectile dysfunction development. In this situation, a psychotherapist who engages in cognitive behavioral therapy will help you get rid of such thoughts and ideas and develop a correct and realistic attitude to yourself and your sexuality.