Impotence/Erectile Dysfunction (cont.)
Stephen W Leslie, MD, FACS
Joseph A Salomone III, MD
Francisco Talavera, PharmD, PhD
Schedule enough time with your doctor to conduct a full interview and physical examination. The first step in the medical management of erectile dysfunction is taking a thorough sexual, medical, and psychosocial history. Erectile dysfunction is a delicate topic, and your doctor should be sensitive and caring to make you comfortable about sharing these intimate details of your private life.
- Your doctor will ask if you have difficulty obtaining an erection, if the erection is suitable for penetration, if the erection can be maintained until the partner has achieved orgasm, if ejaculation occurs, and if both partners have satisfaction.
- You will be asked about current medications you are taking, about any surgery you may have had, and about other disorders (history of trauma, prior prostate surgery, or radiation therapy, for example).
- The doctor will want to know all medications you have taken during the past year, including all vitamins and other dietary supplements.
- Tell the doctor about your tobacco use, alcohol intake, and caffeine intake, as well as any illicit drug use.
- Your doctor will be looking for indications of depression. You will be asked about libido (sexual desire), problems and tension in your sexual relationship, insomnia, lethargy, moodiness, nervousness, anxiety, and unusual stress from work or at home.
- You will be asked about your relationship with your partner. Does your partner know you are seeking help for this problem? If so, does your partner approve? Is this a major issue between you? Is your partner willing to participate with you in the treatment process?
- Your doctor will want your candid answers to questions like these:
- How long has a problem existed? Did a specific event such as a major surgery or a divorce occur at the same time?
- Do you have diminished sexual desire? If so, do you think it is just a reaction to poor performance?
- How hard or rigid are your erections now? Are you ever able to obtain an erection suitable for penetration even momentarily? Is maintaining the erection a problem?
- Can you achieve orgasm, climax, and ejaculation? If so, does it feel normal to you? Does the penis become somewhat rigid at climax?
- Do you still have morning erections?
- Is penile curvature (Peyronie's disease) a problem?
- What would be your preferred frequency of intercourse, assuming the erections were working normally? How would your partner answer this same question? What was your frequency before the erections became a problem?
- Have you already tried any treatments for ED yet? If so, what were they and how did they work for you? Were there any problems or side effects to their use?
- Are you interested in trying a particular treatment first? Are you against trying a particular type of therapy? If so, what caused you to make this judgment?
- To what degree do you wish to proceed in determining the cause of your ED? How important is this information to you?
- A physical examination is necessary. The doctor will pay particular attention to the genitals and nervous, vascular, and urinary systems. Your blood pressure will be checked because several studies have demonstrated a connection between high blood pressure and erectile dysfunction. The physical examination will confirm information you gave the doctor in your medical history and may help reveal unsuspected disorders such as diabetes, vascular disease, penile plaques (scar tissue or firm lumps under the skin of the penis), testicular problems, low male hormone production, injury, or disease to the nerves of the penis and various prostate disorders.
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