The Urological Exam

A thorough urological exam consists of a number of procedures. Not every doctor does all of them, but I list several of the main ones here for your information.

History-taking: This consists of getting information from you about the problem, and is not much different from what a therapist does. Some of the important questions are: Exactly what is the problem (don’t get erections, get them but lose them quickly, penis is full but not rigid)? Under what circumstances do you get erections? Under what circumstances do you not? When did the problem start? Has it changed since then? How is your general health and what medications are you taking? What about alcohol and recreational drugs? These questions are the ones you should address yourself before seeing the doctor (or therapist).

Blood tests: Although hormonal deficiencies account for only a very small percentage of erection problems, most workups include blood tests to determine your level of testosterone, the so-called male sex hormone. The main effect of low testosterone is diminished sexual interest, so if your desire for sex has decreased and you’re having erection problems, a series of blood tests will show if your levels are abnormally low.

Your blood sugar may also be checked for diabetes, a frequent cause of erection problems. It’s possible that complications of the disease are causing or contributing to your erection difficulty.

Nocturnal penile tumescence (NPT) test: This is a test to determine if and what kind of erections you have while you sleep. Since it’s typical for men to have erections during rapid eye movement (REM) sleep, the stage of sleep during which we dream, this is a good way of determining whether the problem is physical or not. NPT monitoring involves a device attached to your penis that records its activity while you sleep. It doesn’t sound too appealing, but I assure you it’s painless. This test can be done at a medical school or university sleep center (very expensive), or at your home (much less expensive though not quite as reliable). It shows how often you get erections, how full they are, and how long they last. The best NPT monitoring is done with a device called a RigiScan; it measures not only penile fullness but also rigidity.

Although NPT is a reliable test, it’s not perfect. If your sleep is disturbed for any reason — because of depression, for example, or discomfort because of having the device attached to you — false readings may occur. Since one’s sleep can be easily disturbed by being in a strange place (a sleep center) and having a device hooked up to one’s body (at a sleep center or at home), NPT testing is usually done for two or three nights. That way, it can be determined if the readings of the first night are valid or due to sleep disturbances. One limitation of the NPT is that even if it indicates the problem is physical, it doesn’t pinpoint what the physical problem is and more tests need to be done. Nonetheless, NPT is very useful in any comprehensive workup.

There are several poor men’s versions of the NPT tests. One involves a device called a Snap-Gauge, a strip of plastic with a Velcro closing that is placed around the penis before going to sleep. An erection will break the little plastic bands on the gauge, thus indicating that your penis got full. Unfortunately, it doesn’t say anything about how many erections you had, how long they lasted, or how rigid they were. Even less reliable results are achieved with the so-called stamp test. This involves placing a ring of several postage stamps around your soft penis before you go to sleep. A good erection will break the ring. The results of this test depend on a number of things — for example, how tightly you secure the stamps to your penis — and, like the Snap-Gauge, they say nothing about how long the erection lasted or how firm it was. Another problem is that if you move around a lot while you sleep, both the stamps and the Snap-Gauge may break and falsely indicate you had an erection.

Yet another test of nocturnal erections requires no equipment at all and can be done before you visit a doctor or therapist. But it requires a willing partner. She has to stay awake all or part of the night to observe what your penis is doing. If you have an erection, she can check it for rigidity and she can also note how long it lasts. Obviously, this requires a great deal from your partner, but the knowledge can be valuable. If she is not a sound sleeper, she may already have this information. A number of women have told me, “I don’t know why he can’t have an erection when we try to make love. He’s always jabbing me with something hard in the middle of the night.”

Papaverine or prostaglandin injections: This consists of a relatively painless injection of a drug, papaverine or prostaglandin, into the spongy tissue of the penis. This causes the arteries and smooth muscles to relax and allow increased blood flow into the penis. If you get and maintain a good erection as a result of the injection, this suggests that the blood supply to your penis is in good order and that the problem lies elsewhere, in psychological or other medical areas. Giving yourself such injections is also used as a treatment.

Checking penile blood flow: Several other tests may be done to determine if sufficient blood is getting into the penis. One of them is a radar-like device, called a duplex Doppler, that can help determine how well your penile arteries are working.

Another test, a cavernosogram, involves taking X rays after dye is injected into the penis. This test can give crucial information about whether the blood in your penis is leaking out, thus making it difficult or impossible to maintain an erection.

DRUG THERAPY FOR ERECTILE DYSFUNCTION

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