How is erectile dysfunction (ED) diagnosed?

Updated: Aug 08, 2018
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Laboratory testing for ED depends on information gathered during the interview; it is necessary for most patients, although not for all. Such testing may include the following:

  • Evaluation of hormonal status (testosterone, serum hormone–binding globulin, luteinizing hormone [LH], prolactin, thyroid-stimulating hormone [TSH]) – Note that the American College of Physicians (ACP) does not recommend for or against routine use of hormonal blood tests or hormonal treatment in ED patients

  • Screening blood studies (hemoglobin A1c, serum chemistry panel, lipid profile)

  • Prostate-specific antigen levels, if the patient is a candidate for prostate cancer screening (controversial)

  • Urinalysis

Functional tests that may be helpful include the following:

  • Direct injection of prostaglandin E1 (PGE1; alprostadil) into the corpora cavernosa (see the image below)

    A vasodilator such as prostaglandin E1 can be inje A vasodilator such as prostaglandin E1 can be injected into one of the corpora cavernosa. If the blood vessels are capable of dilating, a strong erection should develop within 5 minutes.
  • Biothesiometry – Infrequently indicated

  • Nocturnal penile tumescence testing – Once frequently performed, this is rarely used in current practice, though it can be helpful when the diagnosis is in doubt

  • Formal neurologic testing – Not needed in the vast majority of ED patients, though it may offer some benefit to patients with a history of central nervous system problems, peripheral neuropathy, diabetes, or penile sensory deficit

Imaging studies are not commonly warranted, except in situations where pelvic trauma has been sustained or surgery performed. Modalities that may be considered include the following:

  • Ultrasonography of the penis (to assess vascular function within the penis)

  • Ultrasonography of the testes (to help disclose abnormalities in the testes and epididymides; rarely indicated)

  • Transrectal ultrasonography (to disclose abnormalities in the prostate and pelvis that may interfere with erectile function)

  • Angiography (in patients who are potential candidates for vascular surgery)

See Workup for more detail.


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