Diagnosis is usually from a detailed history given to a health care practitioner. Duplex ultrasound may be used to evaluate blood flow, venous leak, signs of artherosclerosis, and scarring or calcification of erectile tissue. Penile nerves function tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Specific nerve tests are used in patients with suspected nerve damage as a result of diabetes or nerve disease. Nocturnal penile tumescence (NPT) is testing done while the man is asleep; it is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis.
Oral medications used to treat erectile dysfunction include selective enzyme inhibitors that increase the amount of nitric oxide, which dilates the blood vessels e.g. sildenafil (Tradename – Viagra), vardenafil HCl (Tradename- Levitra) and tadalafil (Tradename- Cialis). Selective enzyme inhibitors are available by prescription and may be taken up to once a day to treat ED. They improve partial erection. There have been problems associated with the use of these drugs, eye problems leading to blindness and sudden death. The cannot be taken concurrently with medications for heart disease.
Vacuum devices (commonly known as “Swedish Pumps”) work best in men who are able to achieve partial erections on their own. They are easy to use at home, require no other procedure, and typically improve erections regardless of the cause of impotence. Some men experience a numbing feeling afterwards. Since the penis is flaccid between the ring and the body, the erection may be somewhat floppy. Vacuum devices work by manually creating an erection.
Surgery usually has one of three goals: to implant a device that can cause the penis to become erect; to reconstruct arteries to increase flow of blood to the penis; to block off veins that allow blood to leak from the penile tissues. Implanted devices, known as prostheses, can restore erection in many men with ED.