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What to Expect When You See Your Doctor for Erectile Dysfunction

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Many men, when faced to erectile dysfunction, are reluctant to see a doctor.

There’s really no reason to be embarrassed!  Over 30 million men in the United States have ED, so it’s an issue that doctors deal with regularly.

It’s very important to see a doctor, because ED can sometimes be a symptom of a serious medical condition.

Diagnosis

Your doctor will begin by asking questions about how often you experience ED.  He may ask you to fill out a five-question form, the SHIM test for assessing ED.  He’ll also ask questions about your health (do you smoke, how often do you drink alcohol, etc).

He will conduct a basic “check up,” listening to your heart and lungs, checking blood pressure, etc.

He will probably also order blood and urine tests.

  • Blood tests will check for signs of heart disease, diabetes, low testosterone, hormone levels and other health problems.
  • Simple urine tests will look for signs of diabetes and other underlying health conditions.

If your doctor can’t identify the cause of your problem, you may need a referral to a urologist or a specialist at a men’s health clinic.  A specialist will often conduct more in-depth tests, which may include:

  • An ultrasound to check blood flow to your penis. This involves using a wand-like device (transducer) that is passed over the blood vessels that supply the penis. Sometimes the doctor will inject a drug directly into your penis  to determine if blood flow increases normally.  (Don’t worry, this is done with a very small needle that feels like a pin-prick.)
  • An overnight erection test, or “stamp test.”  This involves wrapping special tape around your penis when you go to bed. If the tape is broken in the morning, this means you had an erection in your sleep.  It’s a good way to assess whether your ED is physical or psychological.

The American Urological Association (AUA) has specific guidelines1 for diagnosing erectile dysfunction and its causes:

  1. Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing.  (Clinical Principle)
  2. For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion)
  3. Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle)
  4. In men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C)
  5. For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) 

Treatment

Based on these tests, your doctor should be able to determine the most likely cause of your ED, and recommend an appropriate treatment.  The most common treatment is an oral medication like Viagra, Cialis, or Levitra.  Be sure to ask about generic forms, which are much cheaper.

If the oral medication is not effective, your doctor may raise the dosage, or ask you to try a different medication.  (Some men respond better to one medication than another.)

He may also prescribe testosterone boosters if you have a testosterone deficiency, or vitamin supplements if you have a vitamin deficiency.

If first-line treatments are not effective, your doctor or urologist may recommend other treatments for your ED, which may include vacuum pumps, injections, PRP injection therapy, shockwave therapy, or stem-cell therapy.

In severe cases the doctor may recommend a penile implant.  Penile implants actually have the highest rate of user satisfaction of any treatment option!

The American Urological Association (AUA) guidelines1 for the treatment of erectile dysfunction are:

  1. For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C)
  2. Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C)
  3. Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
  4. When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Strong Recommendation; Evidence Level: Grade C)
  5. For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Strong Recommendation; Evidence Level: Grade B)
  6. Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Moderate Recommendation; Evidence Level: Grade C)
  7. Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C)
  8. Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C)
  9. Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens. (Conditional Recommendation; Evidence Level: Grade C)
  10. For men with ED who are considering the use of IU alprostadil, an in-office test should be performed. (Clinical Principle)
  11. Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C)
  12. For men with ED who are considering ICI therapy, an in-office injection test should be performed. (Clinical Principle)
  13. Men with ED should be informed regarding the treatment option of penile prosthesis implantation, including discussion of benefits and risks/burdens. (Strong Recommendation; Evidence Level: Grade C)
  14. Men with ED who have decided on penile implantation surgery should be counseled regarding post-operative expectations. (Clinical Principle)
  15. Penile prosthetic surgery should not be performed in the presence of systemic, cutaneous, or urinary tract infection. (Clinical Principle)
  16. For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation; Evidence Level: Grade C)
  17. For men with ED, penile venous surgery is not recommended. (Moderate Recommendation; Evidence Level: Grade C)
  18. For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C)
  19. For men with ED, intracavernosal stem cell therapy should be considered investigational: (Conditional Recommendation; Evidence Level: Grade C)
  20. For men with ED, platelet-rich plasma (PRP) therapy should be considered experimental. (Expert Opinion)

Conclusion

The important thing to remember is that a visit to your doctor is nothing to be stressed about.  Erectile dysfunction is a very common medical problem, and doctors deal with hundreds of cases.

By seeing a doctor, you can determine if you have underlying health problems, and you can get a safe and effective treatment for your erectile dysfunction.




References

  1. Burnett A L; Nehra, A; Breau, R H; et al. “Erectile dysfunction: AUA guideline.” Journal of Urology. 2018; 200: 633. <https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline>

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