Context: Erectile dysfunction (ED) has progressively emerged as an important sentinel marker of cardiovascular and overall health among men. A timely and accurate diagnosis of ED may thus represent a significant opportunity both to diagnose the dysfunction per se and to identify comorbid and potentially life-threatening conditions. Objective: To summarise the diagnostic evaluation of the man presenting with ED. Evidence acquisition: The most recently developed European Association of Urology guidelines, International Society for Sexual Medicine recommendations, and standard operating procedures were analysed. Evidence summary: The basic work-up for a man seeking help for ED should begin by considering that ED may share several modifiable and nonmodifiable common risk factors with cardiovascular disorders and other potentially life-threatening conditions. In this context, a comprehensive medical history should be taken for each patient including the assessment of current medications. A thorough sexual history should also be noted including information about age, sexual orientation, marital status, and sexual experience to gain a better understanding of the man's sexual ecology. Physical examination and laboratory tests for patients with ED are highly recommended but not always necessary. Recommended laboratory tests for men with ED typically include a fasting glucose and lipids profile if not assessed in the previous 12 mo. Hormonal tests must include a morning sample of total testosterone. Some patients may need specific diagnostic tests including the Rigiscan assessment of nocturnal penile tumescence and rigidity, a dynamic duplex ultrasound penile blood flow evaluation, a dynamic infusion cavernosometry or cavernosography, or an internal pudendal arteriography. Conclusions: Most patients with ED can be adequately managed with a basic diagnostic work-up that includes a comprehensive medical and sexual history, along with a physical examination and some laboratory tests. Some selected patients may also need specific diagnostic tests. Erectile dysfunction (ED) has emerged as an important sentinel marker of overall health among men. A timely and accurate basic work-up for ED diagnosis may represent an opportunity to diagnose ED and to identify potentially life-threatening conditions.
- Cardiovascular disorders
- Colour duplex Doppler ultrasound
- Erectile dysfunction
- Sexual history
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