How is the diagnosis of erectile
Erectile dysfunction or "impotence"
means you can't get or keep an erection that will allow you to penetrate
your partner during sex; note that problems such as lack of sexual
desire are not the cause of what we call erectile dysfunction, though
you may not get an erection if you don't desire your partner.
varies from the complete inability to get an erection through to the
occasional failure of your erection during sex. It also refers to the
situation where a man can only keep an erection for a brief time.
It's been estimated that one visit in fifty to a
doctor's office is related to erectile dysfunction! And it's become much
more widespread in later years - or, at least, the reporting of it has.
Maybe the fact that men are much more willing to talk to their doctors
about erectile dysfunction is something to do with the fact that there
has been so much publicity about Viagra lately?
It's surprising to think that Viagra has been
around for about ten years now; apparently it is mentioned about three
million times a year in doctor's offices, even during appointments which
were for conditions that had nothing to do with erectile dysfunction.
Apparently one man in twenty at the age of forty has erectile
dysfunction; and up to a quarter of men at the age of 65 are
experiencing some problems with erectile dysfunction.
The mechanism of erection
Two chambers known as the corpora cavernosa run
along the centre of the penis; these chambers are filled with spongy
tissue with great capacity for expansion. The urethra, along which semen
and urine flows, is located under the corpora
cavernosa; its surrounded by the corpus spongiosum.
An erection begins to develop when a man has
either physical or mental stimulation. Nerve impulses make the muscles
of the corpora
cavernosa relax, and this permits blood to flow in. As it does so, it
expands the tissues of the corpora cavernosa and causes the penis to
increase in size. The tunica albuginea (the tissue around the corpora)
is less flexible - it traps the blood, preventing it flowing out, and
therefore keeps the penis erect.
Arteries (top) and
veins (bottom) run through the corpora cavernosa and the corpus spongiosum.
You get an erection when when relaxed muscles allow the corpora cavernosa to
fill with blood. At the same time, the veins are blocked and blood
cannot flow out.
Diagnosis of erectile dysfunction
man's medical history can reveal certain causes of erectile dysfunction,
while a review of sexual activity might bring to light problems with
sexual desire, libido, erection, ejaculation, or orgasm.
Amazingly, the side effects of drugs can account for 25 percent of
erectile dysfunction, and changing medications can often alleviate the
A physical examination can be helpful in elucidating problems in this
area. For example: if a man's penis does not have normal sensitivity,
this may indicate a problem in the nervous
system; hormonal problems might be revealed in the state of a man's
musculature or body tissue; and an erect penis with a significant bend
might indicate Peyronie's disease, which can cause erectile problems.
Biochemical tests can also be useful: blood counts, urine analysis, lipid
levels, liver enzymes, and
free testosterone levels in the blood can provide information about
the endocrine system and are very useful for men with a low level of sexual desire.
Monitoring erections that occur during sleep (also
known as nocturnal penile
tumescence) can eliminate physical causes of erectile dysfunction.
A man in good health will have involuntary erections as he sleeps; if he
does not, his erectile dysfunction is most probably caused by a physical
- Erectile dysfunction is consistent failure to get or keep
an erection hard enough for completing of sexual intercourse.
- Erectile dysfunction is seen in 10 to 20 million American men.
- Erectile dysfunction often has a physical cause.
- Erectile dysfunction is always treatable.
- Treatments available include drug therapy, psychotherapy, vacuum
By far the most effective treatment plan is a complete program
of exercise, sensual training, erection development and techniques to
increase sexual arousal and response. You can find my own program for
dysfunction treatment here.
Erectile dysfunction checklist
If you're having trouble getting an
erection, this checklist
may be helpful in sorting out your thoughts and feelings, and perhaps even pointing
to the cause of the problem, before you see a doctor.
Question 1: What is your problem?
1 Low sexual desire in general
2 Low sexual desire for my partner
3 Not feeling aroused (turned on)
4 Not getting an erection sufficient for intercourse
5 Not keeping an erect penis
6 Not having an orgasm, even though I feel aroused
7 Ejaculating too quickly (coming too fast)
8 Having an orgasm that lacks intensity
9 Having an orgasm but not being able to ejaculate
10 Pain during sex
Interpretation of Question 1
Answering the question should get to the heart of your problem. Some men are able to
get an erect penis but cannot ejaculate or have an orgasm. Some men can erect and ejaculate but experience a decline in the intensity of the orgasm. Others are able to ejaculate and have orgasm with a soft penis. Some men can attain an erection but not sustain it in order to penetrate and complete the sex act. Others can erect and penetrate but ejaculate too quickly to satisfy themselves or their partner. Some men will experience pain in the genitalia with sexual activity. Having defined your problem, let's determine the cause.
Question 2: When is the last time you had what you would consider a complete, normal erection followed by ejaculation?
Interpretation of Question 2
It is important to estimate the time of onset of your difficulty. Impotence of short duration is very often psychologically related to a specific event or has a physical cause such as beginning a new medication or having gone through a surgical procedure.
Erectile dysfunction of a longer duration and
which has come on slowly but progressively usually has a physical cause such as poor blood flow.
Question 3: Are you able to achieve an erection with masturbation? If so, what percent of a full erection do you get?
Interpretation of Question 3
Being able to achieve a fully hard penis with self-stimulation or that provided by your partner indicates normal blood and nerve supply to your penis. Being able to become erect with masturbation but not for intercourse usually indicates a psychological problem.
Question 4: When you awaken during the night or in the morning, what percent of a full erection have you seen in the last few months?
Interpretation of Question 4
Erections that occur during the night are indicative of normal nerve and blood flow to the penis. As previously noted, every normal male will have three to five erections at night, each lasting 20 to 25 minutes. These are not generally appreciated by the male (although they may be by his partner) because they only occur at a certain depth of sleep. The erection that is noted upon awakening, contrary to popular opinion, is not due to a full bladder. It is a reflection of one of the normal erections occurring during rapid-eye movement sleep. The presence of these erections is a very favorable sign and often points to a psychological cause.
Question 5: If you read erotic material or see an erotic movie, what percent of a full erection do you usually get?
Interpretation of Question 5
An erection brought about by an erotic thought or visual stimulus is initiated in the brain. This is a very favorable sign and again is indicative of normal function of the nerve and blood supply to the penis, suggesting a psychological cause.
Question 6: Are you able to get a good firm erection at some times and not at others?
Interpretation of Question 6
If you get a good-quality erection at any time that is sufficient to complete the act of intercourse, yet at other times you are impotent, it is quite likely that your difficulty is psychological.
Question 7: Does erectile difficulty occur only with a certain partner?
Interpretation of Question 7
If you are impotent only with a certain partner but can perform successfully with someone else, there is not likely to be any physical problem causing impotence. (This is not a suggestion that you try multiple partners, particularly if you are married.) It does, however, suggest that sex therapy or marriage counseling should be considered.
Question 8: Does your partner know that you are seeking help and have come for an evaluation?
Interpretation of Question 8
If an impotent male has discussed the problem with his partner, it indicates good communication. Treatment is more likely to be successful if his partner is aware.
Question 9: Is your partner supportive of your seeking help?
Interpretation of Question 9
Men who have supportive partners are more likely to experience a quick recovery. Men whose
partners are not supportive are generally angry and resentful, which does not help the healing process.
Question 10: Do you find your partner sexually attractive?
Interpretation of Question 10
Men who are no longer "turned on" by their partner are more likely to experience impotence.
Men who do not accept the normal changes in a partner's body that occur with aging may have unrealistic expectations and desires.
Question 11: Has your sexual problem caused any of the following difficulties in your relationship?
1. "Chilly" atmosphere in the house
2. Less overall communication
3. Avoidance of specific topics like sex
4. More arguing
5. Withdrawal from family members or friends
6. Less trust in my partner
7. Less trust in me by my partner
8. Doing fewer activities together
Interpretation of Question 11
Like a stone cast in the water, a sexual problem may have a ripple effect upon a couple's entire
relationship. Arguing, avoidance, distrust, frustration, and discouragement or depression are more likely to occur in either or both individuals.
Question 12: Do you or does your partner usually initiate sexual activity?
Interpretation of Question 12
If one partner always initiate sexual activity, it may be indicative of widely differing levels of
interest in sex or reflect negative feelings about the relationship. In an ideal world, each partner may initiate sex at
different times depending upon urge, interest level, and a desire to satisfy each other.
Question 13: Do you feel it is important that your female partner climax during every episode of intercourse? Do you feel that all sexual encounters must include intercourse?
Interpretation of Question 13
If you feel that you must guarantee your female partner has an orgasm during every sexual encounter or that you must achieve sexual penetration and vigorous thrusting, you may be placing unrealistic demands on yourself, which may lead to sexual failure.
PAST MEDICAL HISTORY QUESTIONS
Question 14: Do you have or have you had in the past any of the following?
1. High blood pressure
2. Heart disease
3. Heart attack
5. Thyroid gland disease
6. Testicular disease
7. Multiple sclerosis
8. Parkinson's disease
9. Other neurological disease
11. Kidney disease
Interpretation of Question 14
Any of these illnesses may indicate a general medical problem that can cause difficulties with sexual functioning. It is important that your physician, psychologist, or counselor be fully aware of such problems. All of these may indicate an underlying physical cause of impotence.
Question 15: Have you had any of the following surgical procedures?
1. Removal of the prostate
2. Removal of the bladder
3. Rectal or colon surgery
4. Cardiac bypass
5. Disk surgery
6. Vascular surgery of the legs or major blood vessels
Interpretation of Question 15
Any of these operations may indicate a physical cause for your impotence because of an impairment of blood flow or nerve function.
Question 16: What medications do you take?
Interpretation of Question 16
Commonly prescribed medicines such as antidepressants, blood pressure pills, sedatives, hormones, drugs for peptic ulcer, and
over-the-counter cold medications can contribute to erectile failure. You should review your medications with your physician. However, keep in
mind that most men who take these medications do not experience impotence.
Question 17: Did your sexual problem begin soon after taking a new drug?
Interpretation of Question 17
If you can document in your mind that your difficulty began soon after starting a new medication, this may be a very important
point. It suggests that this drug may be causing or contributing to your problem.
Question 18: Have you ever had an erection that lasted several hours?
Interpretation of Question 18
A past history of an excessively prolonged erection (usually more
than four to six hours) may prevent future erections. This is due to damage caused to the erectile tissue, which is generally not reversible.
Question 19: Do you smoke, abuse alcohol, use illicit drugs, or have high cholesterol? Do you believe that you are not in good physical condition?
Interpretation of Question 19
Any of these factors, smoking, elevated cholesterol, abusing alcohol, or failing to exercise, may contribute to difficulties with sexual functioning.
Question 20: Do your legs ache when you walk more than a few blocks?
Interpretation of Question 20
Poor blood supply to the pelvis and the legs, which is usually caused by atherosclerosis, may indicate poor blood flow to the penis, which may cause impotence.
Question 21: If you have heart disease or have had a heart attack, are you
fearful of dying during intercourse or is your partner fearful of having sex with you for this reason?
Interpretation of Question 21
Anxiety following a heart attack may keep you from resuming a normal sexual life. If your partner has major concerns, she may be unwilling to participate in sex for fear of precipitating a heart attack or stroke. Many men who have suffered from such an illness and whose partner refrains from sex out of concern for them often misinterpret her restraint as a lack of interest.
These questions and your answers are intended only as a framework to help you
understand your problem and to aid a professional sex counselor or a physician
in managing your case. Many men who answer these questions will figure out for
themselves whether the cause of their impotence is likely to be psychological
or physical, or both. Most are relieved once they have taken a step toward
understanding their own diagnosis. Once you pinpoint your difficulty, you will
have a better understanding of diagnostic tests or treatment that your
physician may recommend.
More information on the causes of erectile
[ ED checklist ] [ The symptoms of ED ] [ Psychogenic or organic ED? ] [ Guidelines for the treatment of Erectile Dysfunction (1) ] [ Revised guidelines for the treatment of ED (2) ] [ Primary and secondary ED or erectile dysfunction ]
Other pages on this website about erectile dysfunction and impotence
[ Home ] [ The diagnosis of ED ] [ Erectile dysfunction treatment ] [ The causes of ED ] [ Treatment for ED ]
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