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For a patient with ED, the physical examination should not differ substantially from that performed routinely by a primary care physician. The doctor looks for evidence of hypogonadism or congenital conditions in which there is defective testicular function. The examination of the genitourinary, circulatory and neurologic systems might be especially emphasized. The patient's genitalia are carefully examined for testicular size and consistency and penile deformities. A rectal examination is needed to evaluate the size and consistency of the prostate gland and for the performance of certain muscular reflexes. Vital signs such as blood pressure and pulse would be recorded. Because the presence of ED may serve as a marker for high blood cholesterol, hypertension, coronary artery heart disease, and depression, the physician may also request blood work and/or may perform other assessments to check for these conditions.
Nocturnal studies present a true picture of erectile dysfunction due to organic causes. The most complete evaluation of nocturnal erectile function is obtained in a sleep laboratory, where patients are monitored for rapid eye movement (REM) sleep.
Duplex Doppler ultrasonography has been used extensively in the evaluation of erectile function. It provides information about both arterial and venous blood flow.
Pharmacological testing involves intracavernosal injection of a small amount of an active agent (such as 10 micrograms of alprostadil [prostaglandin E1]) that would produce a normal or priapic erection in a patient with normal erectile function but a poor response in a patient with erectile dysfunction.
There are several patient self-administered questionnaires available to assist in the evaluation of sexual function in men with erectile dysfunction. The best known and most widely used is the International Index of Erectile Function (IIEF). The IIEF addresses the five relevant domains of male sexual function: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.
Author Info: Ralph Myerson M.D., The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Mental Disorders, 2003
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