Erectile Dysfunction Initial Assessment

Clinical Presentation

In erectile dysfunction, complete loss of penile rigidity is uncommon. A patient may complain of partial erection that could not attain vaginal penetration. Initial penile penetrations can penetrate but early detumescence occurs without ejaculation. There may also be nocturnal penile tumescence. There is also an inability to maintain erection during private masturbation and/or erections related to erotic material or other partners.

History

Initial evaluation requires a thorough sexual, medical, and psychosocial history. The sexual history reveals a patient consistently or recurrently unable to maintain an erection adequate for sexual satisfaction. One may use validated psychometric questionnaires such as the International Index for Erectile Function (IIEF) and Sexual Health Inventory for Men (SHIM).

Erectile Dysfunction_Initial Assesment

Physical Examination

In the physical exam, one may focus on the genitourinary (penis, testicles, secondary sexual characteristics), cardiovascular, and neurological systems. Neurologic function is assessed if spinal cord disease is suspected. Cardiovascular examination is also performed (eg blood pressure [BP], heart rate, lower extremity pulses, waist circumference, weight with body mass index [BMI] calculation). A digital rectal examination is not mandatory in erectile dysfunction but should be done in the presence of a genitourinary or protracted secondary ejaculatory symptoms.