Erectile dysfunction can be a sign of a serious underlying medical condition such as diabetes and cardio-vascular disease.  For example, about 10% of patients with ED have undiagnosed diabetes. In addition, men with ED are twice as likely to suffer from a heart attack or stroke. Dr. Lazare will not just diagnosis and treat your ED.  He will also diagnose any underlying medical conditions that can adversely affect your health. If you have questions about the diagnosis of Erectile Dysfunction then contact the Brooklyn, New York Urologist today.

History and Physical Exam

The evaluation of ED starts with a history and physical exam.  Dr. Lazare will thoroughly discuss your ED issue with you and cover the following topics:

The Medical History

The erection is a vascular event.  During the erection, blood rushes into the penis and fills two cylindrical bodies called the corpora cavernosa.  In order for the erection to occur, the arteries to the penis must be healthy and free of atherosclerosis. If a patient suffers from atherosclerosis, he is likely to also suffer from ED.  Consequently, the risk factors for atherosclerosis are the same as the risk factors for erectile dysfunction.  

The risk factors for atherosclerosis and for ED include diabetes, hypertension, abnormal lipid profile, obesity and a sedentary lifestyle.  Dr. Lazare will focus upon these factors during your consultation.

Medications can also interfere with erectile function.  Especially important are medications for hypertension and for psychiatric disorders. It may be possible for your psychiatrist or hypertension doctor to safely switch those medications that adversely impact your ability to have an erection.

The Surgical History

The most important operation that can interfere with erectile function is the radical prostatectomy performed for prostate cancer. Dr. Lazare will discuss the best ED treatment options for this unique group of patients.

BPH and ED

BPH or benign prostatic hyperplasia produces an enlargement of the prostate and obstruction to the flow of urine.  Patients with BPH have a higher risk of erectile dysfunction.  

The mechanism as to how BPH causes ED is not clear.  Relaxation of the smooth muscle surrounding the penile artery and corpora cavernosa are essential to the erection process.  Some studies show that BPH interferes with penile smooth muscle relaxation.  

Dr. Lazare will discuss your urinary symptoms with you.  If you have BPH, Dr. Lazare will suggest a treatment that may improve your ability to urinate and your ability to have an erection.  

The Sexual History

Dr. Lazare will ask you questions pertaining to all aspects of sexual function including libido or level of interest in sex, erection, orgasm, and ejaculation.

One important question pertains to when your ED started.  Primary ED means that ED has been present all your life. Secondary ED means ED followed a period of normal sexual function.    

Another important question is whether you have more difficulty obtaining or maintaining the erection.  Difficulty obtaining an erection implies an arterial inflow problem while difficulty maintaining an erection implies a problem with the veins called a “venous leak”.  During the erection, the veins are supposed to stop draining blood from the penis. Veins that continue to drain blood can cause ED. 

The Psychosocial History

Dr. Lazare will inquire as to whether you suffer from any psychiatric disorders including anxiety, depression, bipolar disease or schizophrenia.  These questions will help to distinguish between organic and psychogenic ED.   

Physical Exam

Dr. Lazare will examine your penis for signs of penile plaque indicating Peyronie’s disease.  Examination of the testis and secondary sex characteristics may help determine whether you suffer from an underlying endocrine problem.  Gynecomastia or breast enlargement is also a sign of a hormone problem.

Dr. Lazare will also check your blood pressure and he will check your pulses.  Hypertension and atherosclerosis are important causes of ED.  

Dr. Lazare will also check your weight as obesity and metabolic syndrome are important causes of ED.    

Laboratory Testing

You will then undergo basic blood testing for ED.  These tests include fasting glucose, testosterone – total and free, and lipid profile.  These tests allow screening for underlying medical conditions including diabetes, dyslipidemia and abnormal hormone levels.

Penile Doppler Ultrasound

The next step in the evaluation of ED is the penile Doppler ultrasound. During the first part of the test, Dr. Lazare injects a medicine called prostaglandin E 1 through a small needle into the side of the penis.  The medicine causes maximal dilation of the penile arteries and should cause you to have an erection.

Dr. Lazare then performs a Doppler ultrasound of the penile arteries.  This test measures the rate of arterial blood flow. If the peak systolic blood flow is over 25 cms/sec, then the penile arteries are normal.  Lower flow rates indicate arterial insufficiency.  

This ultrasound test also allows Dr. Lazare to visualize the arteries and judge whether they appear normal.  Dr. Lazare can also observe the quality of the erection after prostaglandin E 1 injection. This observation provides additional information concerning overall erectile function.

Pelvic Arteriogram

 Arteriography is appropriate for the young man with ED who has experienced pelvic trauma.  The arteriogram can identify a discrete site of arterial injury which can then be repaired by a vascular surgeon.  

Nocturnal Penile Tumescence

This test can distinguish psychological ED from organic ED.  It is based on the principle that men normally have erections when they are asleep.  The device measures and records erections during sleep. Patients with psychogenic ED will have normal erections during sleep while those with organic ED will not have erections during sleep.   

Conclusions

The evaluation of erectile dysfunction should be efficient and cost-effective.  All men with ED should have a history and physical exam and they should undergo basic blood testing. 

Additional testing should be reserved for those patients who do not respond to Viagra or to other phosphodiesterase inhibitors such as Cialis or Levitra.  These patients will require additional therapy including self – injection with prostaglandin E 1, or the 3 – piece penile implant.

Dr. Lazare can help answer these questions or any other question you may have regarding erectile dysfunction. If you have other questions, then contact us and find the answers you need.