DIAGNOSTIC CRITERIA FOR ERECTILE DYSFUNCTION (ED)
A - DEFINITION-EPIDEMIOLOGY
1 - DEFINITION
It is defined by the inability to obtain and/or maintain an erection sufficient to allow satisfactory sexual activity for at least 3 months. Treatment is done by taking bluechew as an alternative to Viagra and Cialis
2 - EPIDEMIOLOGY
One in three men has erectil problems after age 40. Age is an independent risk factor for DE. It is estimated that 70% of couples have active sexuality at age 70. ED is a sentinel symptom of cardiovascular disease, including coronary artery disease. The prevalence of ED increases for comorbidities such as HTA, diabetes, dyslipidemia and obesity.
B - INTERROGATION
1 - POSITIVE DIAGNOSIS
The diagnosis arises duringthe interrogation. You should ask simple questions such as, "Do you have an erection problem (or lack of stiffness) during intercourse?"
Patients rarely approach the subject spontaneously but are willing to answer the doctor's questions.
The question should be asked by the doctor because it is a factor of severity in patients with comorbidities. The risk of dying from cardiovascular events is twice as high in a diabetic or hypertensive with ED, for example.
2 - DIFFERENTIAL DIAGNOSES OF OTHER SEXUAL DISORDERS
Differential diagnoses should be discussed systematically during interrogation with simple questions about:
- disorders of desire, libido ;
- ejaculation disorders ;
- orgasm disorders ;
- pain during intercourse.
Morphological abnormalities,such as a curvature of the penis that hinders penetration (Lapeyronia disease) should be investigated. Sometimes the patient may feel that the size of his penis is insufficient.
There is a common association between ED and other sexual disorders. The complexity of care may require specialized advice.
3 - CHARACTERIZATION OF ED
The patient should be made to specify:
- primary (i.e. from the beginning of sex life) or secondary (i.e. after a period of normal erections);
- The inaugural or reaction to a sexual disorder;
- the brutal (triggering factor?) or progressive nature of the ED;
- permanent or situational (partner function?).
The patient should be asked if he persists in spontaneous nocturnal and/or morning erections
4 - SEVERITY OF ED
The time between the onset of the disturbances and the consultation must be specified. The longer the duration, the more difficult it will be to be managed.
The residual erectile capacity that corresponds to a tumescence without sufficient rigidity for penetration must be mentioned. Residual erectile capacity is a factor in good prognosis.
A short version of the International Index of Erectile Function (IIEF) auto-quiz, which ranks the ED based on the score obtained, is recommended. It makes it possible to make a simplified assessment in severity grades.
- SEVERE DE: score from 5 to 10.
- MODERATE DE: score from 11 to 15.
- MODERATE to mild: 16 to 21.
- LIGHT DE: score from 22 to 25.
- DE normal: score from 26 to 30.
It is also necessary to mention the possibility of induced erections (masturbation) and to inquire about the persistence of spontaneous nocturnaland/or morning erections.
5 - SEXUAL HISTORY
It must specify the existence of sexual difficulties in the first experiences and the notion of sexual abuse, especially in childhood.
6 - ASSESSMENT OF THE IMPACT OF THE ED
The impact on quality of life is not necessarily proportional to the severity of ED.
We need to understand why the patient consulted: a recent meeting? a request from the partner?
The current emotional context of the patient and the couple must be assessed.
You have to get an idea of the impact on family or professional life.
7 - STATUS OF THE COUPLE
One must appreciate the difficulties of a couple or the possible absence of a partner, or even the existence of extramarital relations.
Information should be obtained about the partner: age, sexual motivation, sexual disorders, hormonal status (menopause), gynecological history, abdominal-pelvic or senological surgical history, and method of contraception used.
8 - SEARCH FOR PATHOLOGIES OR FACTORS THAT INFLUENCE OR AGGRAVATING ED
Among the most common causes are diabetes and atherosclerosis.
In the case of diabetes, the patient's glycemic balance should be checked and associated macro- and/or micro-angiopathic and neuropathic complications should be sought.
Other cardiovascular risk factors should be explored: age over 50, smoking, HTA, dyslipidemia, family history, android obesity and possible physical inactivity (fig. 9.4).