Search our site 
Advanced Search

Home | Contact us | About us |


You are in Home >> Key Topics >> Andrology

Assessment of patients with erectile dysfunction

Created: 5/10/2005



Appropriate evaluation is important to:

  • Confirm the diagnosis
  • Assess severity of ED
  • Identify associated conditions
  • Identify specific causes of ED which require specific treatment


  • Important for diagnosis
  • Important to distinguish psychogenic from other causes of ED
    • NB Characteristics of psychogenic - Acute onset, presence and rigidity of morning erections
  • Important for severity assessment
    • Traditionally mild associated with problems maintaining erection, worsening ED associated with initiation and eventually absence of erection
    • NB These points probably do not correlate with actual severity, but more likely patient’s perception of severity


Important in assessing severity and response to treatment

International Index of Erectile Dysfunction (IEFF)

  • Developed by Rosen in 1997 [1]
  • 15 item questionnaire divided into 5 sections erectile function, orgasmic dysfunction, sexual drive, intercourse satisfaction and overall satisfaction
  • More recent 5 item version developed as a screening test with 5 levels of severity – 5-7 severe, 8-11 moderate, 12-16 mild to moderate, 17-21 mild, 22-25 no ED [2]


Important in identification of aetiological risk factors

  • External genitalia
  • Endocrine: gynaecomastia, body hair and fat distribution
  • Cardiovascular: BP, heart rate, peripheral pulses and peripheral oedema
  • Neurological: Vibration sensation, bulbocavernosus reflex, lower limb power/co-ordination [3, 4]

Laboratory investigations

Important in identification of aetiological risk factors

  • Diabetes mellitus (DM) – ED can be presenting symptom
    • Most appropriate screening test – fasting blood sugar with a cut-off at 7mmol/l ( WHO )
    • Others include urinalysis, HbA1c, oral glucose tolerance test

  • Dyslipidaemia
    • Fasting lipid screen

  • Endocrine disorders eg hypogonadism, hyperprolactinaemia, thyroid disease
    • Routine testosterone should be performed
    • Measured in the morning
    • If abnormal should be repeated with prolactin, luteinising hormone and follicle stimulating hormone
    • Testosterone exists in 3 forms in plasma – free, bound to sex-hormone binding globulin and bound to albumin
    • Free testosterone is most important biologically
    • Total testosterone cheapest and most widely used [3, 4]

Vascular assessment


  • Reserved for patients whose ED may be amenable to surgery
    • Eg Damage to penile arteries following pelvic/perineal trauma in young men
  • Duplex USS of penile arteries
    • Peak systolic flow velocity (PSV) and end diastolic velocity (EDV) measured
    • NB PSV < 25cm/sec indicates vascular disease
  • Arteriography of internal pudendal arteries
    • Reserved for young men who are candidates for reconstructive vascular surgery with abnormal Duplex findings


  • Duplex USS
    • EDV > 3cm/sec indicates abnormal veno-occlusive mechanism
  • Cavernosography/cavernosometry
    • Gold standard
    • Used for patients considered for surgery with a site-specific leak eg congenital venous leak, leak secondary to Peyronie’s/trauma
    • Flow required to maintain erection measured
    • 3ml/sec indicate abnormal venous leakage


1. Rosen, R., et al., The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology, 1997. 49: p. 822-820.

2. Rosen, R., et al., Development of evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF) as a diagnostic tool for erectile dysfunction. Int J Imp Res, 1999. 11: p. 319-326.

3. Jardin, A., et al. Erectile Dysfunction. in The 1st International International Consultation on Erectile Dysfunction. 2000: Plymbridge.

4. Lue, T., et al. The 2nd International Consultation on Sexual Dysfunctions. in The 2nd International Consultation on Sexual Dysfunctions. 2004: Plymbridge.

SiteSection: Article

Login Status  

You are not currently logged in.
UK/Ireland Registration
Overseas Registration

  Forgot your password?

All rights reserved © 2008.

UrologyUK has been developed by AnaesthesiaUK.