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THE INVESTIGATION OF ERECTILE DYSFUCTION (IMPOTENCE) 
Definition: Erectile dysfunction is defined as the persistent inability to attain or maintain penile erection sufficient for sexual intercourse.
Initial assessment: A thorough medical, sexual and social history and a focused physical examination are the most important factors in the evaluation of the patient with erectile dysfunction.
CAUSES SPECIFIC LABORATORY TESTS
Psychogenic (20%)
Organic causes (80%)
     Vascular aetiologies
        Aging
        Diabetes mellitus Blood glucose
        Chronic renal failure Urea and creatinine
        Hypertension
        Lipid disorders Lipid studies
        Peripheral vascular disease
    Neurological aetiologies
        Diabetes mellitus Blood glucose
        Cerebrovascular accident
        Herniated disc
        Multiple sclerosis
        Spinal cord injuries
    Endocrine (hormone) aetiologies
        Hypogonadism Testosterone: due to the diurnal variation in testosterone, specimens should be collected between 8 am and 10 am.
        Hyperprolactinaemia Prolactin
        Hypo-/Hyperthyroidism Thyroid function tests
Drugs, especially
  • Antihypertensive drugs e.g.
    • Thiazides
    • Spironolactone
    • Methyldopa
    • Reserpine
    • Beta-blockers
    • Alpha-blockers
    • Oestrogens
  • Cimetidine
  • Ranitidine
  • Antidepressants
  • Benzodiazipines
  • Phenytoin
  • Phenobarbitone
  • Lipid lowering medications
  • Cigarette smoking
  • Chronic alcohol abuse

Others

  • Prostate surgery
  • Pelvic surgery

 

Initial laboratory evaluation should include

FBC
Urinalysis and culture
Urea and creatinine
Lipid analysis
Blood glucose
TSH

Testosterone, first morning collection. If testosterone is low, check LH and FSH.
Prolactin, if prolactin is high, rule out stress and medication as a possible cause, otherwise pituitary imaging is required.

PSA - in men with risk factors for prostate cancer

 
REFERENCES
  • National Institute of Health. NIH Consensus Conference. Impotence. JAMA, 1993; 270: 83 - 90
  • Guidelines for the investigation and management of erectile dysfunction. Alberta Clinical Practice Guidelines. June 2001
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