Do I Need to See a Urologist for Erectile Dysfunction?

Erectile dysfunction is diagnosed with a sexual history, a physical examination, and blood tests to determine if there are other underlying medical conditions such as diabetes or low testosterone levels. 

Tests to diagnose erectile dysfunction include: 

• Blood tests
  • Testosterone
  • Cholesterol
  • Blood sugar
  • Thyroid hormones 
• Other tests
  • Ultrasonography (penile Doppler) to check blood flow
  • A shot into the penis with a vascular stimulant to cause an erection
  • Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection
  • Urine tests

Treatment for erectile dysfunction is aimed at enabling a man to achieve and maintain an erection for sexual intercourse. If erectile dysfunction is the result of an underlying medical condition, treating that condition often reverses the ED. 

If the cause of erectile dysfunction from limited blood flow to the penis due to lifestyle habits such as smoking, obesity, or high blood pressure (hypertension), lifestyle modifications to treat ED may include:

• Weight loss in men who are obese
• Exercise regularly
• Eat a healthy, balanced diet 
• Don’t smoke
• Limit or avoid alcohol
• Pelvic floor exercises for men who have diabetes
• Talk to your doctor about using different medications to treat hypertension and pain
  • Do not stop taking any prescribed medication without first talking to your doctor

Medications used to treat erectile dysfunction may include:

• Phosphodiesterase-5 inhibitors 
  • Sildenafil (Viagra) 
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
  • Avanafil (Stendra) 
• Testosterone replacement therapy 
  • Used when man's testes do not make enough of the hormone testosterone
  • Does not work to improve sexual function in men who produce normal amounts of testosterone
  • May be used alone or in combination with a PDE5 inhibitor

If erectile dysfunction is caused by depression or anxiety, treatment that may help cure ED includes: 

• Psychotherapy
• Counseling with a sex therapist for men with performance anxiety
• Medications for depression and/or anxiety

Medical treatments used to treat erectile dysfunction may include:

• Penile self-injection in which a man injects a medication (alprostadil or papaverine) into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection 
• Intraurethral alprostadil (MUSE) uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection
• Vacuum-assisted erection devices involve placing the penis in a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penis. A rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect. 
• Penile prostheses are surgically implanted devices that inflate to allow the penis to become erect
• Revascularization is a surgical procedure used for young men who have experienced pelvic trauma