Evaluation of Sexual Dysfunction

• History
  • Physiologic changes
  • Psychologic dysfunction
  • Organic deterioration
• Physical Examination
  • Look for changes compatible with endocrine disease, i.e., gynecomastia
  • Examine the penis and testes (both size and texture), prostate, and seminal vesicles
  • Thorough neurologic examination
• Laboratory Data, Hormonal Evaluation
  • Screening blood chemistries to rule out diabetes and renal failure
  • A hormonal evaluation that includes testosterone, prolactin, and LH should be obtained
• Special Studies to Evaluate Sexual Dysfunction
  • Psychological testing
    • The Beck Depression Inventory
    • The Minnesota Multiphasic Personality Inventory
  • Nocturnal penile tumescence (NPT)
    • Doppler studies. To detect impaired hemodynamic blood flow parameters
    • [Penile brachial index (PBI): less than 0.7] is considered compatible with arterial vasculogenic impotence
    • Dynamic infusion cavernometry and cavernosography (DICC)
    • Angiography
      • Assessment of autonomic pathways (neurologic testing)
        • Cystometrography and bethanechol supersensitivity testing
        • Perineal electromyography and bulbocavemous reflex latency testing
        • Examination of the suprasacral afferent pathways through testing of the genitocerebral evoked response
          • Assesment of cavernous tissues

References

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• DeGroat WC, Booth AM: Neurol control of penile erection. In: Maggi CA, ed. The Autonomic Nervous System. Nervous control of urogenital system. London, Harwood, 1993, pp 415-513.
• Dinsmore W, Evans C: ABC of sexual health: Erectile dysfunction. Br Med J 318:387-390, 1999.
• Eid JF, Dutta TC: Vacuum constriction devices for erectile dysfunction: A longterm, prospective study of patients with mild, moderate, and severe dysfunction. Urology 54:891-893: 1999.
• Goldstein 1: Current status of surgical correction of vasculogenic impotence. In Lytton B, Catalona WJ, Lipshultz LL eds. Advances in Urology, vol. 7, St. Louis, Mosby, 1994, p 155.
• Arterial revascularization procedures. Semin Urol 4:252, 1986.
• Hashmat AI, Rehman J: In: Hashmat, Das S, eds. The Penis. Philadelphia, Lea and Febiger, 1993.
• Hellstrom, WJG ed: The Handbook of Sexual Dysfunction. San Francisco, The American Society of Andrology, 1999.
• Iacono F, Barra S, DeRossa G: Microstructral disorders of tunica albuginea in patients affected by impotence. Ear Urol 26:233-239, 1994.
• Kirby RS, Carson C, Webster GD, eds: Diagnosis and Management of Male Erectile Dysfunction. London, Oxford, Butterworths-Heinneman, 1991. Krane RJ, Siroky MB, Goldstein I, eds: Male Sexual Dysfunction. Boston, Little Brown, 1983.
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• Lewis R, Barrett DM, eds: Problems in Urology, Impotent Man. Philadelphia, Lippincott, 1991, vol. 5.
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• Lewis RW: Arteriovenous surgeries: Do they make any sense? In: Lue TF, ed. World Book of Impotence. London, Smith-Gordan, 1992, pp 199-220.
• Lue TF: Intracavernous drug administration: Its role in diagnosis and treatment of impotence. Semin Urol 2:100-106, 1990.
• Luc TF: Editorial comment. J Urol 152:1661, 1994.
• Lugg J, Rajfer J: Drug therapy for erectile dysfunction. A UA Update Series, vol. 15, lesson 36, 289-296, 1996.
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• Masters WH, Johnson VE: Human Sexual Inadequacy. Boston, Little Brown, 1970. Montague DK: Editorial: Medical therapies for erectile dysfunction. J Urol 162:732, 1999.
• Montague DK: The current status of penile prosthesis. A UA Update Series, vol. 8, lesson 29, 226-231, 1987.
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• Padmanathan H, Shabsigh R: Sildenafil citrate (Viagara): A review. A UA Update Series, vol. 18, lesson 35, 273-280, 1999.
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