Impotence - characteristics, causes, diagnostic tests for impotence

Impotence is a problem for many men. There can be many reasons for impotence. Some men struggle with erectile dysfunction or complete lack of erection due to the use of certain pharmacological agents. In other cases, impotence is linked to psychological factors such as anxiety disorders, past traumas, and a small penis complex. The first step in diagnosing erectile dysfunction is to take a detailed medical history. During the examination, the doctor tries to answer the question of whether erectile dysfunction is organic (caused by a disease) or psychogenic. After the initial diagnosis, the doctor recommends further steps, which may include laboratory testing for impotence.

1. Characteristics and the most common causes of impotence

ERECTILE kind male sexual dysfunction. This problem usually affects mature men, but this is not the rule. It happens that impotence affects younger men. Impotence refers to the following problems: erectile dysfunction of the penis, incomplete erection, complete lack of erection, erection problems, loss or decrease in sexual sensitivity. Impotence usually occurs due to poor blood flow. This situation means that a man cannot achieve a full or permanent erection.

Here most common causes of impotence:

• psychogenic impotence - may be associated with anxiety disorders, trauma, small penis complex, situational stress, low self-esteem, homosexuality.
• Hormonal impotence - can be caused by too low testosterone levels or too high prolactin levels in the body.
• circulatory impotence - can be caused by arterial hypertension, atherosclerosis, or changes in the blood vessels of the penis.
• Drug impotence is commonly associated with high blood pressure medications, antidepressants, and drugs known as antipsychotics.
• neurogenic impotence - occurs in men with spinal injuries, discopathy, in persons addicted to psychoactive substances. Common causes of neurogenic impotence are also neurological problems, strokes, or brain tumors.

In 1/4 of men, specialists diagnose the so-called mixed impotence.

2. Diagnosis of impotence

The first step in diagnosing erectile dysfunction is to take a detailed medical history. During a visit to the office, the doctor conducts a thorough examination of the penis and testicles. In addition, the specialist conducts an approximate test for skin sensitivity. It is extremely important to measure the blood pressure of a person suffering from impotence. The physician should also assess the blood supply to the patient's extremities (assessment of the groin and lower extremities is appropriate). During the medical examination, a neurological examination is also carried out to assess the state of the patient's nervous system.

Evaluation of the latency of the bulbocavernosus reflex is nothing more than a dianostic method for assessing the bulbocavernosal reflex. During the examination, the specialist inserts a gloved finger into the rectum and slightly squeezes the patient's penis. After pressing on the penis, you should feel the tension in the rectum with your finger.

2.1. Laboratory studies carried out in the diagnosis of impotence

Laboratory studies carried out in the diagnosis of impotence:

• elementary blood test Anemia can also cause fatigue erectile disfunction,
• glucose levels in blood serum and urine - to exclude diabetes mellitus,
• lipid profile - allows you to determine the level of cholesterol. A high level may indicate a risk of atherosclerosis, which blocks the blood supply to the penis.
• thyroid function assessment (TSH, fT4) - thyroid hormones affect the production testosterone. Therefore, thyroid hormone deficiency can affect erectile dysfunction,
• assessment of renal (urea, creatinine) and liver parameters (liver enzymes, bilirubin), which will allow to evaluate the work of these organs,
• general urinalysis - in addition to the presence of glucose (detection of diabetes mellitus) may indicate kidney disease,
• PSA is an antigen that is determined in diseases of the prostate gland.

In more complex cases, or when the treatment suggested based on the current diagnosis is ineffective, more complex additional studies may be performed to determine the cause of erectile dysfunction.

Specialized endocrinological examinations are not routinely performed. They are usually recommended to men who, in addition to erectile dysfunction, note a decrease or loss of libido (sex drive), loss of sexual characteristics, such as male hair. These include:

• testosterone levels - the hormone is taken in the morning, when it is at its highest concentration in the blood,
• prolactin - especially in young men with loss of libido. A high level of this hormone reduces the amount of testosterone in the blood and, through an unknown mechanism, affects decreased libido and erectile dysfunction
• LH/FSH.

3. Ultrasound of the penis

Ultrasound of the penis is another diagnostic tool that allows you to assess the patient's health status. In the diagnosis of impotence, specialists use Ultrasound of the deep arteries of the penis. This test is performed after intracavernous administration of vasodilators. The test is performed if vascular erectile dysfunction is suspected. The purpose of the test is to show the correct blood flow in the vessels of the penis, and in case of violations, to diagnose whether the problem is obstructed inflow or outflow of blood from the penis.

The next examination is an ultrasound of the pelvic organs and a transrectal examination. Thanks to these diagnostic tools, the doctor can determine the condition of localized organs.

in the pelvic area. It is also possible to identify potential hypertrophy of the prostate gland (prostate).

In the diagnosis of impotence, specialists also use ultrasound examination of the testicles and epididymis. With these tests, a doctor can confirm or rule out dysfunction of these organs. This test is especially important when the patient suffers from hormonal erectile dysfunction (he has low testosterone levels).

4. Other methods for diagnosing impotence

In addition to laboratory tests and ultrasound, there are other methods for diagnosing impotence. Currently, a commonly used diagnostic method is a test injection into the cavernous body of the penis. Intracavernal injection is

a vasodilator is injected into the cavernous body (most often alprostadil is an analogue of prostaglandin). Obtaining an erection after the administration of the drug excludes a vascular cause as the cause of the lack of erection. The method can also be used as a post-treatment for erectile dysfunction. Many men are afraid of this injection, as well as the complications that can occur when using a trial injection. The method can cause fibrosis at the patient's injection site. Among other complications, doctors mention bumps, bruises and curvature of the penis.

Another way to recognize impotence evaluation of nocturnal erections of the penis, which is an unscheduled examination. Evaluation of nocturnal penile erection can determine whether erection problems are caused by psychological or organic factors. During a night of REM sleep, there are usually 3-5 penile erections. Psychiatric erectile dysfunction is characterized by normal nocturnal erections, while organic erectile dysfunction is less common or absent.

Arteriography of the internal iliac artery is nothing more than an invasive imaging study, which is rarely performed, except in cases where erectile dysfunction is caused by trauma or previous surgery in this area. Arteriography is useful in people who are potential candidates for vascular surgery, such as young people after accidents.

Cavernosometry and cavernosography are tests that allow you to verify blood pressure inside the cavernous bodies and identify places of increased venous outflow, which contributes to erectile dysfunction. The test involves inserting two small needles into the penis and injecting saline, erection medication, and x-rays.

The study of vibration sensation is a diagnostic method that allows relatively quickly, quantitatively (objectively), outpatient assessment of vibration sensation, which is one of the most sensitive indicators of sensory neuropathy. The patient who will undergo the vibration sensitivity test should arrive at the office rested and refreshed. Do not smoke before the examination. Statistics show that spring and autumn are particularly optimal times of the year to take the test. The vibration sensation test is used in affected individuals.

sensory disturbances in diabetic neuropathy.

5. Testosterone and erectile dysfunction

Hormonal factors play a very important role in erection. Testosterone is considered an important hormone for human sexual function, but its role is still not fully understood. It is known, however, that one of the causes of impotence are hormonal disorders in the hypothalamic-pituitary-testicular system. Diseases of other endocrine glands that disrupt the work of this endocrine axis can also have a negative effect. However, only about 5% of patients who see a doctor for erectile dysfunction have low testosterone levels. Many studies show that decreased testosterone levels are primarily responsible for decreased libido, abnormal development of male sexual characteristics, and depression. Therefore, determining the level of free testosterone is recommended especially in men who, in addition to impotence, have additional, disturbing symptoms.

Laboratory studies for impotence are carried out only after collecting a comprehensive survey and conducting internal examinations. Based on the available data, the doctor prescribes a certain set of laboratory tests. It should be noted that there is no single standard research scheme, and the decision is always made adequately to the specific situation.

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