Erectile Dysfunction — Impotence

Questions to Discuss with Your Doctor:

• Do you smoke cigarettes?
• Have you been screened for other medical problems such as high cholesterol, high blood pressure, heart disease, and diabetes?
• Do you have a neurologic disease or sickle-cell disease?
• Are you taking any medications (prescription or over-the-counter)?
• Has your erectile dysfunction worsened since starting any new medications?
• What effect is your erectile dysfunction having on your relationship? Your self-esteem?
• How long have you had erectile problems?
• Do you have erectile problems sometimes or all of the time?
• Have you ever had any psychologically stressful sexual experiences?
• Are you less interested in sex (diminished libido)?
• Are you having difficulty achieving an erection or sustaining it?
• Do you ever awaken with early morning or nocturnal erections?
• Do you have pain with erections?
• Penile bumps or lumps?
• History of penile trauma?
• History of pelvic surgery?
• What are your goals in receiving treatment?
• What therapies have you tried?
• Do you know how much benefit you can expect from medical therapies?
• Do you know the side effects and important drug interactions?
• Do you know the pros and cons of a penile prosthesis?
• Do you know the types of penile prosthesis and how they work?

Your Doctor Might Examine the Following Body Structures or Functions:

• Genital examination
• Rectal examination
• Neurologic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests (complete blood count or CBC, glucose, cholesterol panels, thyroid function tests, prolactin level)
• Blood testosterone level (if libido is decreased)
• Nocturnal penile tumescence (NPT) (see p. 1093)
• Neurologic testing (nerve condition studies)
• Psychological evaluation
• Your doctor may decide to do some vascular tests to establish whether the arteries that supply blood to the penis during erections are narrowed.
• Your doctor may do some tests to establish whether there is an abnormal blood flow out of the penis during erections leading to short-lived or partial erections.