Before diagnosing erectile dysfunction (ED) your GP will ask you about:
- your symptoms
- your overall physical and mental health
- your alcohol consumption
- whether you take drugs
- whether you are currently taking any medication
Sexual history
Your GP will also need to ask you detailed questions about your sexual history. Try not to be embarrassed because ED is a common problem. It should be possible to request a male GP at your doctor’s surgery if you prefer.
Your GP may ask about:
- your previous and current sexual relationships
- what your sexual orientation is
- how long you have been experiencing ED
- whether you can get any degree of erection with your partner, on your own or when you wake up in the morning
- whether you have been able to ejaculate or orgasm
- your libido (your level of sexual desire)
ED that occurs all the time may suggest an underlying physical cause. If ED only occurs when you are attempting to have sex with your partner it may suggest that there is an underlying psychological (mental) cause.
Assessing your cardiovascular health
An important cause of ED is narrowed blood vessels. These are also a risk factor for cardiovascular disease (conditions that affect the heart and blood flow). Your GP may therefore assess your cardiovascular health by seeing if you have any of the risk factors for cardiovascular disease. If you do, it is likely that this is what is causing your ED.
Your GP may:
- measure your blood pressure to see if you have high blood pressure (hypertension)
- listen to your heart rate to check for any abnormalities
- measure your height, weight and waist circumference to see if you are a healthy weight for your height
- ask you about your diet and lifestyle, for example, how much exercise you do
- test a sample of your blood for glucose (sugar) and lipids (fatty substances), as high levels can indicate conditions affecting your heart or blood vessels
If you are at risk of developing cardiovascular diseases, further tests for ED will not usually be necessary.
Physical examinations and tests
Your GP may carry out a physical examination of your penis to rule out anatomical causes (conditions that affect the physical structure of your penis).
If you are over the age of 50, your GP may suggest that you have a digital rectal examination (DRE). This involves your GP wearing gloves and inserting a finger into your anus (back passage). A DRE can be useful for diagnosing problems with the prostate (the small gland between the penis and the bladder), such as prostate cancer.
Blood tests may also be used to check for possible underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone).
Further testing
Further testing for ED is usually only required if you are unusually young to be experiencing ED. This is because ED is relatively rare in men who are under 40. Your GP may also recommend further testing to identify the exact cause of your erectile dysfunction, for example, in case of an abnormality in the blood vessels in your penis.
If it is thought that your ED is related to cardiovascular disease, these tests are rarely necessary.
Nocturnal penile tumescence and rigidity (NPTR)
A nocturnal penile tumescence and rigidity (NPTR) test involves monitoring you over two nights in hospital to see if you get an erection during the night. Most healthy men have erections when sleeping. During the test, a piece of perforated tape will be tied to the base of your penis. If you have an erection during the night, the tape will break.
A NPTR test is a useful way of determining whether ED is due to physical or psychological causes.
Intracavernous injection test
An intracavernous injection test involves injecting a synthetic (man-made) hormone into your penis to increase the blood flow to your penis. This may be used to assess any abnormalities in your penis to help plan surgery.
If the injection fails to produce an erection it may indicate that there is a problem with the blood supply to your penis. If you do get an erection during an intracavernous injection test, it is still possible that there is a problem with your blood vessels. You may therefore need an ultrasound scan as well.
Duplex utrasound scan
A duplex ultrasound scan uses high frequency sound waves to create an image of part of the inside of your body. It can be used to measure blood flow inside your penis. See the Health A-Z topic about Ultrasound scans for more information about how they work.
Arteriography and dynamic infusion cavernosometry or cavernosography
These are specialised tests that involve injecting dye into the blood vessels of your penis and studying the dye on a scanner. These are only likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels.
Psychological assessment
If there may be an underlying psychological cause for your ED, your GP may refer you for a psychological assessment. This could be with:
- a psychologist - a healthcare professional who specialises in the assessment and treatment of mental health conditions
- a psychiatrist - a qualified medical doctor who has received further training in treating mental health conditions
