Definition of Erectile Dysfunction, Diagnosis of Erectile Dysfunction
Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. The 1992 National Institutes of Health (NIH) Consensus Development Conference recommended the use of erectile dysfunction as the preferred term to impotence, the former being more precise. There is no universal consensus or agreed criteria as to how consistent the problem (i.e., inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance) has to be and for what duration it should last to fulfill this definition. A period of persistence over 3 months has been suggested as a reasonable clinical guideline.
The diagnosis of ED involves a clinical evaluation including medical/physical examination as well as documentation of sexual and psychosocial history. Erectile dysfunction is one of many symptoms of sexual disorders including premature ejaculation, increased latency time associated with age, psycho-sexual relationship problems, and loss of libido. During diagnosis of ED, it is important that other sexual dysfunctions (e.g. loss of libido) be recognized and taken into account. A few validated instruments are used in diagnosing ED, grading its severity, and assessing treatment satisfaction. Some examples of such instruments are the International Index of Erectile Function (IIEF),15 the modified 5-item version of IIEF (IIEF–5), and the Erectile Dysfunction Index of Treatment SatisfactionEDITS). The IIEF is a self-administered 15-item questionnaire consisting of five distinct domains:
- erectile function (total score range 1– 30),
- orgasmic function (total score range 0–10),
- sexual desire (total score range 2–10),
- intercourse satisfaction (total score range 0–15),
- overall satisfaction (total score range 2– 10).
Recommendations based on biochemical investigation may consist of hormonal screening to detect hypogonadism or other underlying common diseases such as hyperprolactinemia, diabetes and dyslipidemia. Other methods that may be used are urine analysis, blood count, lipid levels, or prostate-specific antigen (PSA) concentration. There are also specialized evaluation techniques such as duplex ultrasonography, penile tumescence studies, RigiScan, test injections, audio-visual stimulation and penile brachial index measurement.