How is erectile dysfunction diagnosed?
The diagnosis is made in several steps. In addition, there are various examination options, as the causes can be so varied.
In the first step, an informative conversation provides an exact picture of the problem. Both triggers and symptoms are precisely determined. Standardised questionnaires are often used for this purpose. In addition, the attending doctor asks about previous operations, general illnesses and the intake of medication.
In the physical examination, the main focus is on the prostate and the sexual organs. Blood pressure is also tested, as circulatory disorders are a common cause of erectile dysfunction.
A detailed blood test focuses on blood sugar and blood lipid values. The testosterone level is also examined in this step. Ideally, this examination should take place in the morning, as the value is highest.
Additional examinations are necessary in rare cases
As a rule, the above mentioned examinations are sufficient to diagnose the reasons for erectile dysfunction. However, if no cause can be determined, there are other possibilities.
Doppler sonography: This ultrasound examination examines the blood flow in the vessels of the penis. Whether an erection is achieved can be determined by injecting certain drugs into the penis. This test is called 'erectile tissue injection test'.
Nerve tests: To rule out nerve disorders as the cause, doctors set weak electrical impulses and check whether these signals are transmitted by the nerves.
Nocturnal penile tumescence measurement: Spontaneous erections - such as those that occur at night in every healthy man - can be measured in a sleep laboratory. If the nocturnal penile tumescence measurement shows that an erection is possible, psychological causes are likely.
Heart examination: An examination of the heart is necessary if arterial circulatory disorders are frequently detected. The reason: erectile dysfunction can be the harbinger of serious heart disease.
What are the treatment options?
Affected men are primarily interested in one thing: What can be done about erectile dysfunction? Once the cause has been found, it can usually be treated specifically. In general, only the symptoms can usually be treated. How the therapy looks like is individually different. There are the following possibilities:
Changing medication: If erectile dysfunction occurs as a side effect of a drug, the treating doctor will prescribe an alternative.
Remedy testosterone deficiency: Testosterone levels decline with age. Basically this is not a problem. But if a man suffers from erectile dysfunction, the low testosterone level may be to blame and it is important to compensate for it. A combination of medication and hormone therapy is often particularly effective. There are cases of erectile dysfunction, where men whose levels are actually within the normal range benefit from testosterone supplements. However, this must be discussed individually with the doctor.
Psychotherapy: If there are psychological causes for erectile dysfunction, psychotherapeutic treatment can help. It is also useful as an additional treatment for organically caused erectile dysfunction, as physical and psychological causes cannot usually be precisely separated. Important: The partner should definitely be involved in the treatment. As a rule, the statutory health insurance company pays the costs for a medically prescribed psychotherapy.
Vacuum therapy: A transparent plastic cylinder with a suction pump is placed on the penis and a vacuum is created. Blood flows more strongly into the erectile tissue and an erection is produced. A rubber ring at the root of the penis prevents the blood from flowing back again. Important: It is essential to remove this ring after 30 minutes in order to avoid circulatory problems and thus damage to the penis. If the vacuum pump is prescribed by a doctor, the statutory health insurance usually pays.
Medication-based treatment of erectile dysfunction
There are drug therapies that can be used to treat erectile dysfunction. Before prescribing medication, it must always be clarified whether the person concerned has a cardiovascular disease that speaks against the therapy.
Effect: In the treatment of erectile dysfunction, the so-called PDE-5 inhibitors (phosphodiesterase-5 inhibitors) are considered standard today. After sexual stimulation, they trigger a slackening of the muscles in the erectile tissue. This promotes blood circulation in the penis. In addition, the PDE-5 inhibitors prevent the blood accumulated in the erectile tissue from draining away too quickly. As a result, the erection is strengthened and prolonged.
What is to be considered? The PDE-5 inhibitors do not provide sexual stimulation. Ergo, they can only work if this has already taken place. The effect usually sets in after about 30 minutes and lasts for different lengths of time. Studies have shown that this medication helps about 60 to 80 percent of those affected. The health insurance does not cover treatment with PDE-5 inhibitors; the drug is only available with private prescriptions.
Possible side effects: Headaches are a relatively common side effect. It can also lead to a blocked nose, reddening of the skin, back pain and digestive disorders. In the case of certain diseases (e.g. cardiovascular disease), the medication must not be taken. Nor should it be taken in combination with antihypertensive drugs.
MUSE = Medicinal urethral system for erection:
Effect: Active ingredients for the treatment of erectile dysfunction can also be administered in the form of 'mini suppositories' via the urethra. With the help of an applicator the man introduces a certain prostagladin into the urethra. The active substance is then transported through the urethral wall into the erectile tissue of the penis. The result: The blood flow increases and after about 15 minutes an erection is achieved, which usually lasts 30 to 60 minutes.
What is to be considered? It is essential to consult with your doctor whether this medication may be used. If the partner is pregnant, a condom should be used to minimize the risk of premature labor.
Possible side effects: You may experience pain in the penis, burning in the urethra, headache, or dizziness. Certain conditions preclude use of this medicine, such as leukemia.
SKAT = erectile tissue autoinjection therapy:
Effect: In this therapy the man injects the medication into the erectile tissue of the penis with a very thin needle. Thereby more blood flows into the penis. After ten to 15 minutes an erection is achieved, which lasts for about an hour.
What should I be aware of? It is important to pay attention to the exact dosage. An overdose can result in an erection that lasts for hours. This must be treated medically, otherwise the penis may be damaged. If this therapy is prescribed by a doctor, in most cases it is prescribed by the health insurance company.
Possible side effects: If one takes care that no overdose occurs, this therapy is usually unproblematic and painless.
Erectile tissue implants:
If all other treatments have been unsuccessful, plastic cavernous body implants can be surgically inserted. There are various methods for this. In most cases, fillable implants are used.
Here's how it works: Using a pump and a reservoir of table salt, the man can fill the implant so that a kind of erection is achieved. As with any surgical procedure, there are some risks. For example, the operation damages the erectile tissue. Therefore, after such an operation, it is not possible to switch back to other therapy options (tablets, SKAT). However, 60 to 80 percent of patients are permanently satisfied with this method.
In the event that the penile arteries are not permeable enough or are even closed, a special vascular operation can be used to create a new connection between the arteries. Another method is used when there is increased blood flow in the penile veins. This involves closing one or more veins, thus preventing the accumulated blood from draining away too early.