madman
Super Moderator
37.1 Introduction
The evaluation of the male who presents with erectile dysfunction (ED) can be one the most impactful visits in the long-term health of the patient. As illustrated in this chapter, ED has a number of important implications for overall men’s health. ED may be the only symptom that convinces a man to seek medical advice, which he may have avoided for many decades. This can be described as a “delicate” or “sensitive” topic for many men as feelings of masculinity, vitality, and self-worth are often wrapped up in sexual performance. Furthermore, cultural norms have served to stifle open discussion of mores and sexual function. The issue of penetrative sex or intercourse is rarely discussed by men. It is important to remember that a man presenting to a physician’s office with ED may have needed to build up a significant amount of courage to come forward, often not only needing to speak to the provider performing the evaluation but also a number of other staff including call centers, schedulers, medical assistants, nurses, etc. The goal of the ED evaluation is to elucidate the emotional and physical well-being of the patient and to provide a safe and comfortable environment that allows the clinician to perform a proper and complete evaluation. Moreover, we have found many patients lack an understanding of the etiology of their ED, and part of the evaluation should include detailed patient education on how lifestyle and medical comorbidities contribute to ED.
37.1.1 Epidemiology
37.1.2 Public Health Implications
37.2 Initial Detection
37.2.1 Screening
37.2.2 Sexual History
37.2.3 Questionnaires
37.3 Medical History
37.3.1 Comorbidities and Medications
37.3.2 Social History/Lifestyle Factors
37.4 Physical Exam
37.5 Diagnostic Testing
37.5.1 Laboratory Evaluation
37.5.2 Penile Function Evaluation
37.5.3 Cardiac Risk Assessment
37.5.4 Psychological Evaluation
37.6 Conclusions
Evaluating the male with ED includes a detailed and comprehensive patient history and a focal physical exam. Attention should be paid to the development of a therapeutic relationship with the patient and with consideration paid to a shared decision-making process. Evaluation should be performed in a nonjudgmental atmosphere. This will allow the patient to freely express the nature and extent of his ED and will allow for a more comprehensive treatment plan of available options and therapeutics. The physician–patient relationship should not be diminished, as this rapport will allow for a strong bond and a foundation for which to introduce, emphasize, and support the lifestyle changes that often drive ED and can improve it over time. This results in motivated patients who are committed and responsive to suggestions of regular exercise, efforts at weight loss, healthy eating, and smoking cessation.
Of utmost importance is the evaluation of cardiac risk factors. For many men, seeking care after the development of ED might be their first encounter with the healthcare system since their childhood. A properly balanced assessment will result in important long-term implications for the overall health of the patient and future morbidity. This is a unique opportunity to intervene in a patient’s health and put them on a path to improved health and well-being.
The evaluation of the male who presents with erectile dysfunction (ED) can be one the most impactful visits in the long-term health of the patient. As illustrated in this chapter, ED has a number of important implications for overall men’s health. ED may be the only symptom that convinces a man to seek medical advice, which he may have avoided for many decades. This can be described as a “delicate” or “sensitive” topic for many men as feelings of masculinity, vitality, and self-worth are often wrapped up in sexual performance. Furthermore, cultural norms have served to stifle open discussion of mores and sexual function. The issue of penetrative sex or intercourse is rarely discussed by men. It is important to remember that a man presenting to a physician’s office with ED may have needed to build up a significant amount of courage to come forward, often not only needing to speak to the provider performing the evaluation but also a number of other staff including call centers, schedulers, medical assistants, nurses, etc. The goal of the ED evaluation is to elucidate the emotional and physical well-being of the patient and to provide a safe and comfortable environment that allows the clinician to perform a proper and complete evaluation. Moreover, we have found many patients lack an understanding of the etiology of their ED, and part of the evaluation should include detailed patient education on how lifestyle and medical comorbidities contribute to ED.
37.1.1 Epidemiology
37.1.2 Public Health Implications
37.2 Initial Detection
37.2.1 Screening
37.2.2 Sexual History
37.2.3 Questionnaires
37.3 Medical History
37.3.1 Comorbidities and Medications
37.3.2 Social History/Lifestyle Factors
37.4 Physical Exam
37.5 Diagnostic Testing
37.5.1 Laboratory Evaluation
37.5.2 Penile Function Evaluation
37.5.3 Cardiac Risk Assessment
37.5.4 Psychological Evaluation
37.6 Conclusions
Evaluating the male with ED includes a detailed and comprehensive patient history and a focal physical exam. Attention should be paid to the development of a therapeutic relationship with the patient and with consideration paid to a shared decision-making process. Evaluation should be performed in a nonjudgmental atmosphere. This will allow the patient to freely express the nature and extent of his ED and will allow for a more comprehensive treatment plan of available options and therapeutics. The physician–patient relationship should not be diminished, as this rapport will allow for a strong bond and a foundation for which to introduce, emphasize, and support the lifestyle changes that often drive ED and can improve it over time. This results in motivated patients who are committed and responsive to suggestions of regular exercise, efforts at weight loss, healthy eating, and smoking cessation.
Of utmost importance is the evaluation of cardiac risk factors. For many men, seeking care after the development of ED might be their first encounter with the healthcare system since their childhood. A properly balanced assessment will result in important long-term implications for the overall health of the patient and future morbidity. This is a unique opportunity to intervene in a patient’s health and put them on a path to improved health and well-being.
