genitourinary disorders
Erectile Dysfunction
Diagnosis of Erectile Dysfunction
Clinical evaluation Screening for depression Testosteronelevel Evaluation should include history of drug (including prescription drugs and herbal products) and alcohol use, pelvic surgery and trauma, smoking, diabetes, hypertension, and atherosclerosis and symptoms of vascular, hormonal, neurologic, and psychologic disorders. Satisfaction with sexual relationships should be explored, including evaluation of partner interaction and partner sexual dysfunction (eg, vulvovaginal atrophy, dyspareunia, depression). It is vital to screen for depression, which may not always be apparent. The Beck Depression Scale or, in older men, the Yesavage Geriatric Depression Scale (see table Geriatric Depression Scale (Short Form) ) is easy to administer and may be useful. Examination is focused on the genitals and extragenital signs of hormonal, neurologic, and vascular disorders. Genitals are examined for anomalies, signs of Male Hypogonadism , and fibrous bands or plaques ( A psychologic cause should be suspected in young healthy men with abrupt onset of erectile dysfunction (ED), particularly if onset is associated with a specific emotional event or if the dysfunction occurs only in certain settings. A history of ED with spontaneous improvement also suggests psychologic origin (psychogenic ED). Men with psychogenic ED usually have normal nocturnal erections and erections upon awakening, whereas men with organic ED often do not. 