Doctors once believed that most erectile dysfunction (ED) was caused by psychological problems. That is no longer thought to be the case.
Some erection problems are psychological. However, doctors now recognize that many cases of ED are caused by underlying medical problems. A physician’s initial evaluation for ED will typically involve taking a simple medical history and performing a physical examination. If this initial evaluation suggests a physical cause for your ED, diagnostic tests may be necessary to determine the underlying cause.
A variety of different tests can be used to identify the cause of your ED.
A detailed physical exam can help your doctor assess your overall health. Your doctor will likely check your blood pressure and ask about any recent injuries or illnesses. They will ask about your current medications or supplements. They will examine the penis and testicles for changes in sensitivity.
Your doctor may want to assess whether any psychological problems could be contributing to your ED. You will probably be checked for signs of stress, depression, and anxiety. Your doctor may ask about your relationship with your romantic partner. Detailed questions about your sex life may also be asked.
Nocturnal Erection Test
Men usually have erections at night as they sleep. Because there are so many different highly coordinated physiologic systems that are required to achieve an erection, the presence of nighttime erections can help determine whether your ED has a physical or mental cause.
A nocturnal erection test can determine if you have nighttime erections. According to the Mayo Clinic, this test involves placing a ring of special tape on the penis before sleep. If you have an erection, the tape will separate overnight. If there is genuine dysfunction of the muscles, blood vessels, hormones, or nerves required to produce an erection, then nocturnal erections will be absent.
This could be due to underlying medical conditions such as stroke, high blood pressure, diabetes, or multiple sclerosis. On the other hand, if all of the biologic systems needed for an erection are functional and the cause of ED is psychological, then nighttime erections will still be present during the deep slumber typical of the REM phase of sleep.
Blood and Urine Tests
Blood and urine tests can detect signs of diseases associated with erectile dysfunction. Such diseases include:
- heart disease
- kidney disease
These tests can also indicate if hormone levels might be playing a role in your ED.
An ultrasound uses sound waves to see inside the body. It is a very effective way of examining blood flow. When a man has ED, an ultrasound can check blood flow in the penis. An ultrasound wand is simply moved over the blood vessels that supply the penis..
Sometimes, an injection may be used to stimulate an erection before this test. Then an ultrasound can check whether blood flow increases appropriately. Pain from the injection is rare. If you do have discomfort, it will likely be mild and go away quickly. However, if you are afraid of injections, talk to your doctor. It may be possible to use an erectile dysfunction drug, such as sildenafil (Viagra), before the test instead.