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Erectile dysfunction (impotence) - Diagnosis
Last reviewed: 04.07.2025
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Diagnosis of erectile dysfunction (impotence) has several goals:
- confirm the presence of erectile dysfunction (impotence);
- determine the severity of erectile dysfunction (impotence);
- find out the cause of erectile dysfunction (impotence), i.e. the disease that caused its development;
- determine whether the patient suffers only from erectile dysfunction (impotence) or it is combined with other types of sexual dysfunction.
Diagnosis of erectile dysfunction (impotence) begins with a detailed conversation with the patient, collecting information about his general health and mental status. General and sexological anamnesis data are analyzed, as well as the state of the copulative function previously and currently. It is necessary to obtain information about the nature of the relationship with the sexual partner, previous consultations and treatment measures.
It is necessary to find out whether the patient suffers from diabetes mellitus, arterial hypertension, atherosclerosis, hypogonadism, renal failure, neurological and mental disorders; collect information about previous surgeries on the urinary and reproductive systems, rectum, long-term use of medications and alcohol abuse.
The nature of the disorder, its duration, stability of manifestation, influence of individual factors and circumstances are specified. It is important to discuss in detail with the patient the quality of adequate and spontaneous erections, as well as to characterize sexual desire, duration of the frictional stage of the copulatory cycle and orgasm. A conversation with the patient's sexual partner is highly desirable.
Analysis of the obtained data allows us to judge the nature of erectile dysfunction (impotence) with a sufficient degree of reliability.
Differences between organic and psychogenic erectile dysfunction
| Organic | Psychogenic |
| It appears gradually | It appears suddenly |
| Violation or absence of morning erections | Normal morning erections |
| Normal sexual history | Problems in sexual history |
| Normal libido | Problems in relationships with a partner |
| Persistence of erectile dysfunction | Erectile dysfunction under certain circumstances |
In order to objectify the patient's complaints and quantitatively characterize copulative disorders, including erectile dysfunction (impotence), as well as save the doctor's time, it is recommended to use special questionnaires - the International Index of Erectile Function, the scale for quantitative assessment of male copulative function, etc.
[ Clinical diagnostics of erectile dysfunction (impotence)
A clinical examination involves assessing the condition of the patient's cardiovascular, nervous, endocrine and reproductive systems.
Given the high prevalence of cardiovascular diseases in individuals with erectile dysfunction (impotence), the scope of the examination should be sufficient to conclude on the admissibility of sexual activity and the absence of contraindications to
the treatment of erectile dysfunction (impotence).
Algorithm for determining the risk of sexual activity in cardiovascular disease (the "Princeton Consensus")
| Low risk | Medium risk | High risk |
| Asymptomatic (less than 3 risk factors for coronary artery disease), controlled hypertension, condition after successful coronary revascularization, uncomplicated myocardial infarction (more than 6-8 weeks old), mild valvular disease, circulatory failure class I (NYHA) | More than 2 risk factors for coronary heart disease, high functional class angina, myocardial infarction from 2 to 6 weeks old, class II circulatory failure (NYHA), extracardiac manifestations of atherosclerosis (cerebrovascular insufficiency, vascular lesions of the extremities, etc.) | Unstable or treatment-resistant angina, uncontrolled hypertension, circulatory failure class III-IV (NYHA), myocardial infarction or stroke less than 2 weeks old, life-threatening arrhythmias, hypertrophic obstructive cardiomyopathy, severe valvular disease |
| Sexual activity or treatment of sexual dysfunctions is possible. Reassessment is carried out regularly once every 6-12 months | An ECG stress test and echocardiography are required, based on which the patient is classified into a high- or low-risk group. | Sexual activity or treatment of sexual dysfunction is postponed until the condition stabilizes |
If the neurological and endocrinological anamnesis, as well as the examination results, reveal characteristic changes, then the patient is subject to consultation with a specialist of the relevant profile. It should be remembered that more than half of men with diabetes suffer from erectile dysfunction.
The study of secondary sexual characteristics allows us to indirectly judge the endocrine function of the testicles, i.e. the androgen saturation of the body and the timeliness of the onset of puberty. The analysis includes body weight, height, body mass index, skeletal structure, the nature and rate of hair growth (face, trunk, pubis), the state of the muscular system, the development and nature of fat deposition, waist circumference, voice timbre, and the presence of gynecomastia.
Analysis of the condition of the reproductive system includes determination of the location of the testicles, their size and consistency; palpation of the epididymis and prostate gland, as well as examination, measurement and palpation of the penis.
Laboratory and instrumental diagnostics of erectile dysfunction (impotence)
The nature and scope of laboratory and instrumental studies are determined individually, taking into account complaints, anamnesis data and clinical examination, as well as the objective need and mood of the patient. Determination of the blood plasma glucose level, lipid profile and total testosterone is mandatory. In cases where a decrease in the content of total testosterone is detected, determination of free testosterone, LH and prolactin is indicated.
Monitoring of nocturnal penile tumescence is used for differential diagnostics of organic and psychogenic forms of erectile dysfunction (impotence). The study is conducted for at least two nights using the Rigiscan device, and if it is not available, using special rings with three control strips of breaks.
A test with intracavernous injection of vasoactive drugs (optimally alprostadil in an average dose of 10 mcg) allows to detect vasculogenic erectile dysfunction (impotence). With normal arterial and veno-occlusive hemodynamics, a pronounced erection occurs approximately 10 minutes after the injection, which lasts for 30 minutes or more.
Diagnosis of erectile dysfunction (impotence) requires the widespread use of ultrasound Doppler imaging of the penile arteries. Erection is induced by pharmacological drugs. The main quantitative indicators are the maximum (peak) systolic velocity and the resistance index. Peak systolic velocity over 30 cm/s and resistance index over 0.8 are considered normal.
If appropriate indications are present, to assess the state of the autonomic innervation of the penis and identify its disorders, a study of the bulbocavernous and cremasteric reflexes, evoked potentials, and EMG of the penis is performed.
Invasive diagnostics of erectile dysfunction (impotence): angiography, cavernosometry, cavernosography (a method of X-ray diagnostics of cavernous veno-occlusive dysfunction and cavernous fibrosis) - are performed in cases where the patient is a potential candidate for reconstructive surgery for erectile dysfunction (impotence).