Erectile dysfunction: What to expect during your doctor visit

(MayoClinic.com) Erectile dysfunction is a common problem, but a number of effective treatments are available. You shouldn't feel embarrassed about discussing erectile dysfunction with your doctor. Initiating a conversation with your doctor is the first step in identifying the cause of your erectile dysfunction and finding the treatment that works best for you. Knowing what to expect can make talking about a sensitive topic easier.

It may be possible for a doctor to diagnose and treat erectile dysfunction in one visit, but follow-up visits may be necessary. Your doctor may want you to return to discuss results of blood tests or other tests — to make sure you understand as much as you can about your condition. Your doctor may also want to talk with your partner or discuss your treatment options with you. While a primary care doctor can usually diagnose and treat erectile dysfunction, in some cases consultation with a specialist such as a urologist or endocrinologist is necessary.

During your initial visit, your doctor will want to confirm the diagnosis of erectile dysfunction, assess the severity of the problem, and identify any treatable conditions that may be linked to your erectile problems — and find possible treatments for them. For most men, this can be done with a basic assessment. In some cases, more involved testing is needed.

Talking to your doctor: What to expect
To identify what's causing the problem and determine the best treatment for you, your doctor will ask detailed questions about your erectile function and sexual relationships. Talking in depth with your doctor about sex may make you feel anxious or embarrassed. But erectile dysfunction is a common medical condition, and doctors are used to discussing it. Your doctor may even ask directly if you're having any sexual issues during a visit for something else. But if you're having erectile problems, don't hesitate to bring up the issue yourself. Many men don't get the treatment they need because they're reluctant to talk to their doctor.

Your doctor will discuss your concerns and expectations, including why you're seeking help now for the problem, what you think the cause of your erectile dysfunction may be, and what you hope to gain from treatment. Your doctor may also want to get your partner's perspective — by asking you or by talking to your partner directly. Your doctor may have you fill out a questionnaire to help determine the cause of your erectile dysfunction or to assess whether treatment is working.

Expect questions about sexual function
Your doctor may ask how long you've had the problem and how concerned you and your partner are about it. Your doctor may also ask if you have tried treatment for erectile dysfunction in the past. Your doctor will likely ask if you have had changes in sexual desire and how often you have intercourse.

To help determine what's causing your erectile dysfunction, your doctor may ask:

• If you can achieve self-stimulated erections
• If you have spontaneous erections at night or when you wake up in the morning
• Whether your erectile dysfunction started suddenly or developed over time
• How long your erections last and how hard they are
• Whether you can maintain an erection long enough to have sexual intercourse
• If sex is painful for you

Be ready to discuss your overall health
Your doctor will want to know if you have any chronic medical conditions, what medications you're taking, and may ask questions about your lifestyle, such as how much you drink and whether you use tobacco. These factors can all affect sexual function.

Health conditions linked to erectile dysfunction include:

• Diabetes
• Heart disease
• Clogged arteries (atherosclerosis)
• Prior surgeries
• Low testosterone (hypogonadism)
• Cancer
• Psychological conditions such as depression

Sometimes erectile dysfunction is linked to the use of medications or lifestyle choices. Things that can cause or worsen erectile dysfunction include:

• Prescription medications, such as certain medications for high blood pressure or psychological conditions such as depression
• Some over-the-counter medications and herbal supplements
• Heavy alcohol use
• Too much caffeine
• Tobacco use
• Poor diabetes control
• Damage to pelvic nerves caused by prolonged pressure from a narrow bicycle seat
• Illicit drugs such as marijuana, MDMA (Ecstasy) and heroin
• Use of narcotic pain medications such as codeine

Physical exam and lab tests
Your doctor will also likely do a physical exam that includes checking your blood pressure, and checking the circulation and nerves to your penis and testicles. Your doctor may also do a digital rectal exam to check your prostate gland.

In some cases, lab tests are needed to determine the exact cause of erectile dysfunction. These may include tests to make sure your erectile dysfunction isn't related to diabetes, low testosterone or other conditions. Because erectile dysfunction can be linked to heart or circulation problems, your doctor may also want to test your cholesterol or do other tests to check your heart or blood flow.

Lab tests may include:

• Tests to check blood counts, blood sugar, cholesterol, thyroid function, prostate-specific antigen (PSA), testosterone or other hormones
• Nocturnal penile tumescence testing — a noninvasive technique you do at home to electronically monitor spontaneous nighttime erections
• Neurological testing to check nerve conditions
• Psychological evaluation
• An ultrasound of the penis to check for narrowed blood vessels or blood flow problems

You'll explore psychological causes of erectile dysfunction
The mind plays an important role in sex - and in erectile function. In some cases, erectile dysfunction can have a psychological rather than a physical cause. If your doctor suspects your erectile dysfunction is linked to a psychological condition, you may need treatment for that condition or your doctor may refer you to a specialist such as a psychiatrist or counselor. Your doctor may want to see your partner as well, and may recommend that you both see a specialist. Signs that suggest your erectile dysfunction may be linked to a psychological problem include:

• Your erectile dysfunction started suddenly rather than coming on gradually
• Your erections subside early during sexual contact
• You can achieve self-stimulated erections
• You have spontaneous erections at night or when you wake up in the morning
• You have premature ejaculation
• You're unable to ejaculate
• You have relationship problems
• You have been going through stressful life events
• You have symptoms of a psychological condition such as depression

Typically, one or two visits to a primary care doctor are sufficient to determine a likely cause of erectile dysfunction and to identify treatment options. However, erectile dysfunction can be related to other conditions. If your doctor suspects your erectile dysfunction is more complicated, he or she may refer you to a specialist such as a urologist to help identify the cause and best treatment. Common reasons that may mean you need to see a specialist include:

• You've always had problems with erectile function
• Your doctor suspects your erectile dysfunction may be caused by an injury
• Your doctor finds abnormalities of the penis or testicles, such as a curved penis (caused by Peyronie's disease) or small testicles (which can be a sign of low testosterone)
• Your screening tests show a significant problem

Oral medications such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are the most common treatment for erectile dysfunction. But these medications aren't effective for all men and aren't safe for men with some health problems or who take certain medications. Other treatments include medications injected into the penis before sex or vacuum constriction devices (penis pumps). For some men, surgery or penile implants are a good treatment option. Treating related health conditions, psychological counseling, or changing medications or lifestyle choices can help when issues such as stress or depression are involved. Your doctor will help you choose the best treatment option. Your doctor will want to monitor side effects and how well treatment is working for you. If the first treatment you try doesn't work, your doctor may suggest trying something else. For some men, a combination of treatments works best.

Infrequent erection problems are probably not a cause for concern. But if it's an ongoing problem, you may need treatment. Bringing up the topic of erectile dysfunction with your doctor can be awkward, but it may be easier than you think to discuss it — and to identify the likely cause and treatment options that might work for you. Erectile dysfunction is a common health problem, but many men are reluctant to seek help. However, treatment is effective for most men — and restoring sexual function can make a difference in your quality of life.

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