Erectile dysfunction (impotence): diagnosis

Diagnosis of erectile dysfunction (impotence) has several objectives:

• confirm the presence of erectile dysfunction (impotence);
• to establish the degree of expression of erectile dysfunction (impotence);
• to find out the cause of erectile dysfunction (impotence), i.e. A disease that caused its development;
• determine whether the patient suffers only by 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 the state of his health in general and mental status. Analyze the data of the general and sexological anamnesis, as well as the state of the copulative function earlier and at the present time. It is necessary to obtain information about the nature of the relationship with the sexual partner, prior consultation and treatment.

It should be determined whether the patient suffers from diabetes, arterial hypertension, atherosclerosis, hypogonadism, renal insufficiency, neurological and psychiatric disorders; to gather information about the surgical interventions carried out on the organs of the urinary and reproductive systems, rectum, long-term drug intake and alcohol abuse.

Specify the nature of the violation, its prescription, the stability of the manifestation, the influence of certain factors and circumstances. It is important to discuss in detail with the patient the quality of adequate and spontaneous erections, as well as characterize the sex drive, the duration of the frictional stage of the copulatory cycle and orgasm. Talking with the partner's sexual partner is highly desirable.

The analysis of the obtained data allows to judge with a sufficient degree of reliability the nature of erectile dysfunction (impotence).

Differences between organic and psychogenic erectile dysfunction

Organic	Psychogenic
Occurs gradually	Appears suddenly
Violation or absence of morning erections	Normal morning erections
A normal sexual anamnesis	Problems in a sexual anamnesis
Normal libido	Problems with a partner
Persistence of erectile dysfunction	Erectile dysfunction under certain circumstances

For the purpose of objectifying patient complaints and quantitative characteristics of copulative violations, including erectile dysfunction (impotence), and saving the doctor's time, it is recommended to use special questionnaires - the International Index of Erectile Function, the scale of quantitative estimation of male copulative function,

[1], [2], [3], [4], [5], [6], [7], [8]

Clinical diagnosis of erectile dysfunction (impotence)

Clinical examination assumes an assessment of the state of the cardiovascular, nervous, endocrine and reproductive systems of the patient.

Given the high prevalence of cardiovascular diseases in persons with erectile dysfunction (impotence), the scope of the examination should be sufficient to conclude that sexual activity is permissible and there is no contraindication to the
treatment of erectile dysfunction (impotence).

Algorithm for determining the risk of sexual activity in cardiovascular diseases ("Princeton Consensus")

Low risk	Average risk	High risk
Absence of symptoms (less than 3 risk factors for IHD), controlled arterial hypertension, condition after successful coronary revascularization, uncomplicated myocardial infarction (prescription more than 6-8 weeks), mild valvular failure, grade I circulatory failure (NYHA)	More than 2 risk factors for IHD, high-grade angina pectoris, myocardial infarction between 2 and 6 weeks old, circulatory failure of the 2nd class (NYHA), non-cardiac manifestations of atherosclerosis (cerebrovascular insufficiency, damage to the vessels of the extremities, etc.)	Unstable or resistant to treatment angina, uncontrolled arterial hypertension, circulatory failure III-IV class (NYHA) myocardial infarction or stroke less than 2 weeks old, life-threatening arrhythmias, hypertrophic obstructive cardiomyopathy, severe valve damage
Sexual activity or treatment of sexual disorders is possible. Revaluation is carried out regularly every 6-12 months	It is necessary to carry out an ECG test with exercise and echocardiography, on the basis of which the patient is classified as high or low risk	Sexual activity or treatment of sexual dysfunction is postponed until the state stabilizes

If the neurological and endocrinological history, as well as the results of the survey, reveal characteristic changes, the patient should be consulted by a specialist of the appropriate 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 incretory function of the testes, i.e. Androgenic saturation of the body and the timeliness of the onset of puberty. The body weight, height, body mass index, skeleton structure, character and tempo of hairiness (face, trunk, pubic area), the condition of the muscular system, the development and nature of the fatty tissue, the waist circumference, the timbre of the voice, the presence of gynecomastia are subjected to analysis.

Analysis of the state of the organs of the reproductive system includes the definition of the localization of the testicles, their size and consistency; palpation of appendages of testicles and prostate. As well as examination, measurement and palpation of the penis.

[9], [10], [11]

Laboratory and instrumental diagnostics of erectile dysfunction (impotence)

The nature and scope of laboratory and instrumental research is determined individually, taking into account complaints, the history and clinical examination. As well as the objective need and attitude of the patient. It is necessary to determine the level of glucose in blood plasma, lipid profile and total testosterone. In cases where a decrease in the total testosterone content is detected, the determination of free testosterone, LH and prolactin is indicated.

Monitoring of night tumescence of the penis is used for differential diagnosis of organic and psychogenic forms of erectile dysfunction (impotence). The study is carried out for at least two nights using a "Rigiscan" device, and in its absence - special rings with three control strips of ruptures.

The test with intracavernous introduction of vasoactive drugs (optimally alprostadil in an average dose of 10 μg) allows to reveal vasculogenic erectile dysfunction (impotence). With normal arterial and venooclusive hemodynamics, after about 10 minutes after the injection, there is a pronounced erection that persists for 30 minutes or more.

Diagnosis of erectile dysfunction (impotence) requires a wide application of USDG of the arteries of the penis. Erection is induced by pharmacological drugs. The main quantitative indicators are the maximum (peak) systolic velocity and the resistance index. Normal is considered a peak systolic velocity of more than 30 cm / s and a resistance index of more than 0.8.

With appropriate indications for evaluating the state of autonomic innervation of the penis and revealing its abnormalities, a study is made of bulbous-cavernous and cremaster reflexes, evoked potentials, EMG of the penis.

Invasive diagnostics of erectile dysfunction (impotence): angiography, cavernosometry, cavernosography (the method of X-ray diagnosis of cavernous veno-occlusive dysfunction and cavernous fibrosis) is performed in those cases when the patient is a potential contender for reconstructive surgical interventions for erectile dysfunction (impotence).