How is Male Impotence Diagnosed?

Patient History

Medical and sexual histories help define the degree and nature of erectile dysfunction. A medical history can disclose diseases leading to ED, while a simple recounting of sexual activity might distinguish problems with sexual desire, erection, ejaculation, or orgasm.

Using prescription or illegal drugs can suggest chemical impotence causes, since drug use accounts for 25% of erectile dysfunction cases. Cutting back on or substituting medications may alleviate the problem.

Physical Examination

A physical examination can give clues to systemic impotence problems. For example, if the penis is not sensitive to touch, a nervous system issue may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement can point to hormonal problems, which would mean the endocrine system is involved. The physician may discover circulatory problems through decreased pulses in the wrist or ankles. Unusual characteristics of the penis itself could suggest the source of the problem. For example, a penis that bends or curves when erect could be the result of Peyronie's disease.

Laboratory Impotence Tests

Laboratory tests can also diagnose erectile dysfunction. Tests for systemic diseases include blood count, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about endocrine system issues and is indicative of patients with decreased sexual desire.

Other Impotence Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out psychological causes of impotence. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then erectile dysfunction likely has a physical, rather than psychological, cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, reveals psychological factors contributing to erectile dysfunction. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.