Episode 115: Erectile Dysfunction Diagnosis.  

Discussion about the diagnosis of erectile dysfunction with Andrew, Adriana, and Dr. Arreaza. Causes, labs, and physical exam is briefly discussed. Written by Andrew Kim, MSIV, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Adriana Rodriguez, MS3, Ross University School of Medicine; and Hector Arreaza, MD.

September 22, 2022.

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In episode 39 o erectile dysfunction, Dr. Ihejirika gave us an overview, but today we will be more detailed about the diagnosis of ED. 

Definition.

The American Urological Association (AUA) published an erectile dysfunction guideline in May 2018, which is available online at no cost. Based on that guideline, erectile dysfunction can be defined as “the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.” Comment: This guideline provides 25 principles for diagnosing and treating ED. 

Diagnosis.

Getting a good history is important when diagnosing erectile dysfunction. The patient should be asked about the onset of symptoms, severity, how much it hinders his sexual performance, whether the patient can get and maintain an erection, psychological factors, social factors, and presence of morning erections. 

One can use different questionnaires: the five-question International Index of Erectile Function (IIEF-5) or a single-question self-assessment. 

Single-question self-assessment:

Impotence means not being able to get and keep an erection that is rigid enough for satisfactory sexual activity. How would you describe yourself?

1. Not impotent: always able to get and keep an erection good enough for sexual intercourse.
2. Minimally impotent: usually able to get and keep an erection good enough for sexual intercourse.
3. Moderately impotent: sometimes able to get and keep an erection good enough for sexual intercourse.
4. Completely impotent: never able to get and keep an erection good enough for sexual intercourse.

Comment: Basically, the single-question self-assessment is a self-diagnosis of erectile dysfunction; the patient is giving you the severity of his condition. This questionnaire seems to be very subjective. 

International Index of Erectile Function (IIEF-5):

IIEF-5 asks five questions, and the patient answers on a scale of 1 to 5 (1 is the worst, 5 is the best)

1. How do you rate your confidence that you could get and keep an erection?
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
5. When you attempted sexual intercourse, how often was it satisfactory for you?

Diagnosis can be made based on the total score. 1 to 7: severe ED, 8 to 11: moderate ED, 12 to 16: mild-moderate ED, 17 to 21: mild ED, and 22 to 25: n