If you are concerned about erectile dysfunction, talk about it with your doctor. Of course, that’s easier said than done. Most people-physicians included-have long found it difficult to talk frankly about sexual problems. But doctors are becoming more responsive to such issues, often at the encouragement of professional medical societies, and medical schools, because of growing awareness of the importance of sexual health. In some cases, your doctor may recommend a reputable counselor trained in sex therapy.

At the doctor’s office, expect to begin by relating your medical history. Do you have any chronic illnesses? What illnesses and operations have you had in the past?

What, if any, medications are you taking? Your doctor is also apt to ask about your psychological well-being: Do you (or have you ever) suffered from depression? Are you under stress? Do you drink alcohol? Smoke? Use illegal drugs? Have you felt a loss of affection for your partner? Have you recently grown interested in a new partner? As part of this health history, be prepared to tell your doctor about the symptoms that brought you to the office and when they began. The doctor might want to know if you’ve had erectile dysfunction in the past and how often you had sex before the current problem started. Your doctor may conduct a written or verbal screening test.

If the cause is clear-a recent operation for prostate cancer, for example-the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and eliminate unnecessary testing. A key issue is whether the symptoms came on gradually or suddenly. Erectile dysfunction that comes on gradually often points to causes that involve blood flow or nerves, such as diabetes or high blood pressure. Sudden loss of sexual desire or the ability to have erections usually suggests that erectile dysfunction was caused either by a medication or by a psychological difficulty, such as depression or stress. Don’t be embarrassed if the doctor asks you about early morning erections which may be an important clue to determine if the problem is psychological or physical.

In the doctor’s office

Possible Cause of Erectile Dysfunction What the Doctor May Do

Vascular (circulatory system) - Takes blood pressure. Listens to heart. Checks pulse in groin and feet. Checks abdomen for aortic aneurysm.

Neurological (nervous system) - Tests reflexes of knees and ankles. Checks for sensation in legs and feet.

Hormonal (endocrine system) - Assesses testicular size. Checks thyroid gland.

Local - Examines penis for Peyronie’s disease. Checks prostate.

Psychological (stress, anxiety, emotional) - Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected. Your doctor may also talk to you about any changes in mood you may be experiencing.

The physical exam for diagnosing the cause of erectile dysfunction usually takes about 10 to 15 minutes.

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SOURCE: The Journal of Urology