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 Investigations of Sexual DysfunctionsBasic Tests for Sexual DysfunctonsMale sexual dysfunctions can be casued by a number of physical factors and illnesses. Research had shown that erectile dysfunction can be an early sign of coronary artery dieases. The arteries in the penis are smaller than those in the heart. Blockages in these arteries causes erectile problems and men will erectile dysfunction should have their cholesterol, bloods sugars, as well as their blood pressure checked. In some case, an ECG or even an exercise ECG may be needed in some individuals. Some men may have a low desire for sex, this may be the cause or as a cause for erectile problems. These men should have their testosterone (male hormone) checked also. Penile BiothesiometryOne useful way to evaluate the nerves that carry sensation away from the penis is by the use of a technique called penile biothesiometry. This is a quantitative measure of the vibratory sense of the penis. A biothesiometer consists of a device that vibrates at a known frequency, and it is compared to other parts of the body with known vibration thresholds. This tends to become less reliable in older patients because as men age they tend to lose sensation. Still, it is a reasonable, cost-effective test. The device is placed on the tip of the finger, and slowly the intensity of the vibration is increased until the vibration is felt. This is then used as a baseline to compare the vibration sense of the penis. It is a useful way to detect early neuropathic disease in younger men, those who had spinal injury and in men with diabetes. It is also used in men who have had circumcisions and complain that the head of the penis has lost sensation. Doppler UltrasoundThe Doppler ultrasound is a relatively simple procedure to evaluate male erectile dysfunction. Doppler ultrasound combined with an intra-cavernous injection is an effective test to evaluate penile blood flow and responses to vasodilation. This single test can evaluate both the early and late stages of an erection, as well as venous leakage. The technique utilizes a special Doppler ultrasound device that uses a computerised system which assesses the blood flow direction and provides a way to evaluate the volume of flow into and out of the penis. The technique is fairly simple. It is done by first taking a waveform of the flaccid penis. It usually includes the corporal bodies and the spongiosum, which is the spongy layer that surrounds the urethra. In some cases, we may induce an erection by injecting prostaglandin. We then repeat the study at one-, five-, and fifteen-minute intervals. Using this technique, we are able to image the cavernosal arteries. If the patient responds poorly to this, we sometimes have the patient perform self-stimulation in order to take out of the equation any results of anxiety or embarrassment that may cause a loss of erection and interfering the results. More Complicated TestsIn some cases, in difficult cases, Rigiscan and caverous angiogram may be needed. Rigiscan is a recorder which a man wears overnight and it measures whether there is any noctural erection in the men. The presence of noctural erection is usually indicative of psychological erectile dysfunction while its absence usually means physical cause. Caverous angiogram may be used in refractory cases. It involves an injection of radioactive dye to show up the vascular struction in the penis. It is usually used in preparation for penile prosthersis surgery. |
