men s health issues
Erectile Dysfunction (ED)
Evaluation of Erectile Dysfunction
An occasional episode of erectile dysfunction (ED) is not uncommon, but men who are consistently unable to achieve or maintain an erection should see their doctor because ED may be a sign of a serious health problem, such as Atherosclerosis or a nerve disorder. Most causes of ED are treatable. The following information can help men know when to see a doctor and what to expect during the evaluation. In men with ED, certain symptoms and characteristics are cause for concern. They include Absence of erections during the night or upon awakening in the morning Numbness in the area between and around the buttocks and genital area (called the saddle area) Painful cramping in the muscles of the legs that occurs during physical activity but is relieved promptly by rest (claudication) Although ED may diminish a man's quality of life, it is not itself a dangerous condition. However, ED may be a symptom of a serious medical disorder. Because numbness in the groin or leg can be a sign of spinal cord damage, men who suddenly develop such numbness should see a doctor right away. Men who have other warning signs should call their doctor and ask how soon they need to be seen and examined. Doctors first ask questions about the man's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause for ED and additional tests that may need to be done (see table Common Causes and Features of Erectile Dysfunction ). Doctors ask about Drug and alcohol use Smoking history History of diabetes History of high blood pressure History of atherosclerosis History of surgery (for example, for prostate enlargement, prostate or rectal cancer, or blood vessel disorders) History of injury (for example, a broken pelvic bone or a back injury) Symptoms of disorders of the blood vessels (for example, pain in the calves when walking or coolness, numbness, or blue color of the feet) Symptoms of nerve disorders (for example, numbness, tingling, weakness, incontinence, or falling) Symptoms of hormonal disorders (for example, loss of sex drive, increased size of breasts, decreased size of testes, loss of body hair, tremor, changes in weight or appetite, or difficulty tolerating heat or cold) Symptoms of psychologic disorders, particularly depression Satisfaction with sexual relationships Sexual dysfunction (for example, vaginal dryness or depression) in the man's partner Even though men may be embarrassed to talk to their doctors about some of these subjects, the information is important in determining the cause of ED. The physical examination focuses on the genitals and prostate, but doctors also look for signs of hormonal, nerve, and blood vessel disorders and examine the rectum. The cause is sometimes clear from the history. For example, ED may occur soon after prostate surgery or beginning a new drug. One important clue is whether erections are present at night or on awakening. When erections are present, a physical cause is less likely than a psychologic cause because physical causes typically inhibit erections at all times. Other factors that suggest a psychologic cause are sudden development in a young healthy man, occurrence of symptoms only in certain situations, and resolution of ED without any treatment. Claudication or coolness or a blue color in the toes or feet may indicate a problem with the blood vessels such as Overview of Peripheral Arterial Disease or vascular disease caused by Testing is usually needed. Laboratory tests include the measurement of the level oftestosteronein the blood. If thetestosteronelevel is low, doctors measure additional hormones. Depending on the results of the history and physical examination, blood tests may also be done to check for previously unrecognized diabetes, thyroid disorders, and lipid disorders. Usually, these tests provide doctors with enough information to plan treatment. Occasionally, doctors inject a drug into the penis that stimulates erection and then use ultrasonography to assess blood flow in the arteries and veins of the penis. Rarely, doctors may recommend the use of a home monitor that detects and records erections during sleep. 