The proper goal-oriented evaluation of a man proactive and complaining of erectile dysfunction requires a sympathetically elicited history, a focused physical examination and various carefully selected special investigations.

HISTORY
To obtain a clear history, it is important that the patient himself understands the distinction between loss of libido, erectile dysfunction and ejaculatory disturbance. This often may require some preliminary explanation. The onset, consistency and severity of the complaint need to be established. Recently, the development of self-administered symptom scores by O’Leary and colleagues and Rosen and colleagues have facilitated quantitative history-taking for erectile dysfunction.

Because sexual function is intimately related to the appropriate response of the sexual partner, tactful enquiries need to be made concerning previous and on-going relationships, and the attitude of the partner towards the problem.

Underlying relationship problems are a common cause of erectile dysfunction, and this possibility needs to be tactfully explored in all cases. Although, by tradition, the question concerning the presence or absence of early morning erections has been proposed as a means to distinguish between psychogenic and organic erectile dysfunction, the value of this enquiry has recently been questioned.

Many normal individuals do not regularly wake up with early morning erections, although the presence of a positive history of a firm erection on waking would make organic erectile dysfunction less likely. Although these symptom scores are admirable in their own way, they in fact tend to focus on the functional component of erectile dysfunction rather than its impact on the quality of life of the sufferer. This issue has recently been addressed by Wagner and colleagues, who have attempted to quantify the impact of erectile dysfunction on the sufferer (Table III).

A careful drug history is particularly important as a considerable number of pharmacological agents are associated with the development of erectile dysfunction. Most potent in this respect are the agents used in the treatment of prostate cancer, such as LHRH analogues, which cause loss of libido and erectile dysfunction. Many other agents have less profound, but none the less significant, effects. Some of the more commonly encountered compounds implicated are listed in Table 6.

 

A Review of Erectile Dysfunction Arterial Blood Supply Venous Drainage Lymphatic Drainage Neuroanatomy Central Nervous System Connections - Mechanisms of erection - Causes of erectile dysfunction Vasculogenic Causes Neurogenic Causes Endocrinological Causes Priapism and Postpriapism ED Psychogenic Causes - Epidemiology of erectile dysfunction - Risk factors for erectile dysfunction - Diagnosis of erectile dysfunction History Physical Examination Special Investigations - Treatment of erectile dysfunction Psychosexual Counseling Medical Therapies Vacuum Decices Surgical Therapies - Erectile Dysfunction - Conclusions

Antihypertensive agents, such as β-blockers and thiazide diuretics, are the most commonly implicated agents. Antidepressants, especially monoamine oxidase inhibitors and tricyclic compounds, are also common causes of erectile dysfunction. Serotonin reuptake inhibitors may not only cause erectile dysfunction, but also retard ejaculation.

The question of smoking and alcohol intake needs to be addressed. William Shakespeare himself noted that alcohol increases the desire, but diminishes sexual performance. Smoking should be strongly discouraged and, in some cases, the use of skin patches containing nicotine suggested.

Specific enquiry should be made concerning concomitant conditions, particularly those affecting the vascular or neurological systems such as angina, hypertension, diabetes mellitus, thyroid disease, renal failure or peripheral vascular disease. The presence of previous pelvic surgery should be ascertained and accurately documented.

 

Table 6