Medical Diagnosis Of Erectile
Dysfunction by Ann Knapp
There are no formal tests to
diagnose erectile dysfunction. Some blood tests are generally done to exclude
underlying disease, such as diabetes, hypogonadism and prolactinoma.
A useful and simple way to distinguish between physiological and psychological
impotence is to determine whether the patient ever has an erection. If never,
the problem is likely to be physiological; if sometimes (however rarely), it is
more likely to be psychological.
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of
atherosclerosis, and scarring or calcification of erectile tissue. Injecting
prostaglandin, a hormone-like stimulator produced in the body, induces erection.
Ultrasound is then used to see vascular dilation and measure penile blood
pressure. Measurements are compared to those taken when the penis is flaccid.
The diagnosis of male impotence is fairly easy. Determining why ED is occurring,
on the other hand, can be more difficult. To accurately identify why a patient
is suffering from ED, a medical professional will usually conduct a
comprehensive patient interview, followed by a physical examination, and
possibly laboratory testing.
The interview may include the following types of questions: Questions relating
to the specific erectile complaint Questions relating to medical factors that
could be contributing to ED Questions relating to psychosocial factors that
could be contributing to ED Questions relating to prior evaluation or treatment
Tests such as the bulbocavernosus reflex test are used to determine if there is
sufficient nerve sensation in the penis. The physician squeezes the glans of the
penis, which immediately causes the anus to contract if nerve function is
normal. A physician measures the latency between squeeze and contraction by
observing the anal sphincter or by feeling it with a gloved finger inserted past
the anus. Specific nerve tests are used in patients with suspected nerve damage
as a result of diabetes or nerve disease.
Nocturnal penile tumescence (NPT) is normal for a man to have five to six
erections during sleep, especially during rapid eye movement (REM). Their
absence may indicate a problem with nerve function or blood supply in the penis.
There are two methods for measuring changes in penile rigidity and circumference
during nocturnal erection: snap gauge and strain gauge.
Penile biothesiometry test uses electromagnetic vibration to evaluate
sensitivity and nerve function in the glans and shaft of the penis. A decreased
perception of vibration may indicate nerve damage in the pelvic area, which can
lead to impotence.
Penile erection is managed by two different mechanisms. The first one is the
reflex erection, which is achieved by directly touching the penile shaft. The
second is the psychogenic erection, which is achieved by erotic stimuli. The
former uses the peripheral nerves and the lower parts of the spinal cord,
whereas the latter uses the limbic system of the brain. In both conditions an
intact neural system is required for a successful and complete erection.
Stimulation of penile shaft by the nervous system leads to the secretion of
nitric oxide (NO), which causes the relaxation of smooth muscles of corpora
cavernosa (the main erectile tissue of penis), and subsequently penile erection.
Additionally, adequate levels of testosterone (produced by the testes) and an
intact pituitary gland are required for the development of a healthy male
erectile system. As can be understood from the mechanisms of a normal erection,
impotence may develop due to hormonal deficiency, disorders of the neural
system, lack of adequate penile blood supply or psychological problems.
Restriction of blood flow can arise from impaired endothelial function due to
the usual causes associated with coronary artery disease, but can also include
causation by prolonged exposure to bright light or chronic exposure to high
noise levels.
A few causes of impotence may be iatrogenic. Various antihypertensive
(medications intended to control high blood pressure) and some drugs that modify
central nervous system response may inhibit erection by denying blood supply or
by altering nerve activity. Antidepressants, especially SSRIs, can cause
impotence as a side effect. Surgical intervention for a number of different
conditions may remove anatomical structures necessary to erection, damage
nerves, or impair blood supply. Some studies have shown that male circumcision
may result in an increased risk of impotence, while others have found no such
effect and another found the opposite.
Excessive alcohol use has long been recognized as one cause of impotence,
leading to the euphemism "brewer's droop"; Shakespeare made light of this
phenomenon in Macbeth.
A study in 2002 found that ED can also be associated with bicycling. The number
of hours on a bike and/or the pressure on the penis from the saddle of an
upright bicycle is directly related to erectile dysfunction.
About the Author:
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Source: This article is taken from
www.goarticles.com
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