Evaluating the man with ED

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Erectile dysfunction can be caused by a diversified variety of factors. Ageing, suffering from certain diseases, smoking, substance abusing, taking certain types of drugs, feeling depressed, stressed out or tired can make your erectile potency dwindle significantly. Viagra online canadian pharmacy can successfully deal with erectile dysfunction brought on by the majority of these factors. However, you should check with your urologist or andrologist if you can safely take sildenafil and have your blood panels taken regularly before and while you do.

A complete evaluation often determines likely etiological factors for ED. The evaluation of ED follows the same pattern as evaluation of any medical disorder, including a pertinent history, physical examination, and laboratory tests. However, this history must include a sexual history. A well-organized brief sexual history can be an effective diagnostic tool. It is better not to accept the patient’s label for a disorder without first questioning and obtaining a clear picture of the complaint. Often, less educated patients misuse medical or technical terminology. For example, because some men con-fuse ED with premature ejaculation, asking if the erection is lost before or after ejaculation can clarify the problem. Learning about the patient’s sexual and relationship histories can also be very revealing.

Questions generally review the phases of male sexual response and focus on problems of desire, arousal/erection, orgasm/ejaculation, and sexual pain. Offering the patient several phrases that describe the same phenomenon in different ways can make communication more clear.

For desire phase disorder, physicians can ask, “Do you still feel in the mood, feel desire, have sexual thoughts or fantasies?” ED preceded by loss of desire can signal hormonal problems, relationship difficulties, adverse effects from medication, and depression. It is difficult for most men to sustain an erection if they feel no desire.

For arousal/erection difficulties, physicians can ask, “Do you have trouble getting or keeping an erection, getting or keeping hard? Or both?” An easy method of distinguish-ing most psychogenic ED disorders from potentially organically induced disorders is to ask if the patient ever has a spontaneous or sexually induced erection at any time? A positive response strongly hints at stress or anxiety as the trigger of the ED rather than a physical cause or medication adverse effect.

For orgasm/ejaculatory phase problems physicians can ask, “Do you feel you ejacu-late, ‘come,’ too quickly (or too slowly or not at all?)?” ED is common in men who, for any reason, became increasingly anxious about quick ejaculations, delayed ejaculation, or perceived absence of ejaculation, as can occur with retrograde emission.

To reveal Peyronie’s disease or pain disorders, a physicians can ask about “a bend to the penis” or pain during or after sexual activity.

Questions about sexuality need to be sensitive to cultural and religious differences. Using terminology that is clear, simple, and respectful of the patient’s feelings can facil-itate communication. Further general questions about sex may reveal deeper misunder-standings or mishaps with sexual activity in the past. These frequently require referral to a sex therapist or viagra australia online shop.

The medical history should include review of risk factors and screening for psycho-logical difficulties. A review of medications, including over-the-counter preparations, may reveal the source of the problem, because medications have been implicated in up to 25% of cases of ED. Medications have adverse effects on all phases of sexual functioning, making clarification of the patient’s complaint a priority before ascribing symptoms to side effects of specific medications. Brief screening for depression, including such questions as “Do you sometimes feel blue, down in the dumps?” may elicit more honest responses than “Are you depressed?” Other psychiatric conditions, such as anxiety, may also be responsible for ED. The social history, which determines stress surrounding a relationship or substance abuse (including alcohol and cigarettes),