This is the final article on Erectile Dysfunction with 2 days to our Men’s Health Awareness Open Day which will be taking place on Saturday 24th June at the Outspan Medical College grounds. We invite all men to attend and get free checkup, treatment and learn more on major health conditions affecting men today. The event starts at 9.00 a.m., share widely.

How is erectile dysfunction diagnosed?
A diagnosis of erectile dysfunction is made in men who have a history of repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least three months. Candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause.
After a interview, the doctor will perform a physical examination check for clues for physical causes of erectile dysfunction.
To confirm the cause of the dysfunction, the doctor may request all or some of the following laboratory tests: -

• Complete blood counts
• Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage.
• Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood promotes atherosclerosis.
• Blood glucose levels: Abnormally high blood glucose levels may be a sign of diabetes mellitus.
• Blood hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels.
• Serum creatinine: An abnormal serum creatinine may be the result of kidney damage due to diabetes.
• Liver enzymes and liver function tests: Advanced liver disease (cirrhosis) can result in hormonal imbalance and gonad dysfunction leading to low testosterone levels. Thus, evaluation for liver disease may be necessary in cases of erectile dysfunction.
• Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 a.m.) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.
• Other hormone levels: Measurement of other hormones beside testosterone (luteinizing hormone (LH), prolactin level, and cortisol level) may provide clues to other underlying causes of testosterone deficiency and erectile problems, such as pituitary disease or adrenal gland abnormalities. Thyroid levels may be routinely checked as both hypothyroidism and hyperthyroidism can contribute to erectile dysfunction.
• PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer.
• Other blood tests: Evaluation for hemochromatosis, lupus, scleroderma, zinc deficiency, sickle cell anemia, cancers (leukemia, colon cancer) are some of the other potential tests that may be performed based on each individual's history and symptoms.

Imaging tests
In a setting of a previous pelvic trauma, X-rays may be performed to assess various bony abnormalities. Ultrasound of the penis and testicles is done occasionally to check for testicular size and structural abnormalities. Ultrasound with Doppler imaging can provide additional information about blood flow of the penis. Rarely, an angiogram may be performed in cases in which possible vascular surgery could be beneficial.

Psychosocial examination
A psychosocial examination using an interview and questionnaire may reveal psychological factors contributing to erectile dysfunction. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

What are the treatments for erectile dysfunction?
The following are treatments for erectile dysfunction:

1. Since many common medications for treating hypertension, depression, and high blood lipids can contribute to erectile dysfunction, working with your doctor to select medications that do not impair erectile function in case you are on regular medication will improve the condition.

2. Life style modification aimed at eliminating modifiable predisposing factors. These include, quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes Some studies suggest that men who have made appropriate lifestyle improvements experience improvement in their sexual performance.

3. Taking drugs to treat Erectile Dysfunction

4. Inserting medications into the urethra 

5. Injecting medications into the muscles of the penis

6. Vacuum constrictive devices for the penis

7. Penile prostheses

8. Psychotherapy techniques are used to decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated. If these simple behavioral methods at home are ineffective, referral to a sex counselor may be advised.