Signs and Symptoms to Expect When Diagnosing Impotence

There are a number of different conditions which can influence sexual performance but not all of these could be classed as impotence.

Impotence presents in a very specific way, and isn’t just a term used to cover all types of sexual dysfunctions.

Impotence can be caused by a number of different conditions so it’s always a very good idea to get checked by a doctor to rule out any underlying cause. It is possible to buy Viagra and other medication from an online pharmacy but you should only ever consider this once you have been properly assessed, and have been given the all-clear by a doctor to take Viagra.

Impotence is the inability to develop or maintain an erection but there are many more signs and symptoms which a doctor could expect to see when diagnosing the condition.

We take a closer look at the signs and symptoms which may present to a GP when he is diagnosing impotence in a man.

Impotence can be part of health check discussions with your GP

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Primary presenting symptoms

If a man has suffered from impotence, this has nothing to do with ejaculation, either delayed or premature. Impotency is the inability to develop an erection, or maintain one sufficiently long enough for sexual intercourse.

Impotence can take many forms and while in some cases, there may be a physical cause, in many cases the cause  will be entirely psychological.

In these cases the individual may still awaken in the morning with an erection, and they may also be able to get an erection during masturbation. But if they cannot develop or sustain an erection during sexual intercourse, it’s likely that the cause is psychological.

Impotence caused by psychological factors is no less serious than impotence caused by physical means; it’s not something they can just ‘get over’. Impotence caused by psychological factors can be profoundly disturbing and can lead to significant distress if left untreated.

Getting a diagnosis

In some cases you may need to go and see a specialist about your impotence, particularly if you have either a hormonal imbalance, you want surgery or there are problems with the anatomy of your penis.

But in the vast majority of cases, your GP will be able to diagnose the condition.

In order to reach a diagnosis, your doctor will listen to what you have to say and may also perform a physical examination. They will also ask you a number of questions which may not always seem relevant, but could be related to your erectile dysfunction in a way which is less than obvious.

If you would rather not see your GP about such a personal matter, you can also go to your local genitourinary medicine clinic (known as GUM clinics). You should be aware though that your GP will be very experienced in dealing with matters of a sexual nature and that this kind of complaint won’t raise an eyebrow.

Whoever you see, they will ask you a range of questions which will cover the symptoms you are suffering from, your overall health, both physical and mental, whether you use recreational drugs, any medication and your alcohol intake.

It’s really important that you’re honest when talking to the doctor; they aren’t there to get you into trouble but need to understand what could be impacting on your overall health.

How your erection is affected
Impotence manifests as an inability to develop and maintain a firm erection, resulting in penetrative sex being impossible.

Your doctor will need to understand the exact symptoms you suffer when you are trying to get an erection, and how and when these symptoms appear. They will also need to take details about your sexual history.

It may feel a bit uncomfortable talking about such personal matters in a clinical setting, but the details are needed in order to ascertain whether the cause is likely to be psychological or physical.

Some of the questions you may be asked include
your sexual orientation
details of past and present sexual relationships
how long you have been having problems maintaining an erection
how strong your libido is (the desire to have sex)
the times when an erection may occur: for example, do you still wake up with an erection, can you achieve one on your own or do you only have difficulties when attempting sex with a partner?
whether the erectile problems have prevented you from orgasming or ejaculating

Impotence is a problem which affects over half of men at some point during their lifetime, so the issue is probably far more widespread than you think. All doctors will be able to handle the matter sensitively and diplomatically, but you can ask to see a male doctor if you would be more comfortable.

Physical checks
Before treating impotence, it’s necessary to rule out any underlying cause and that means looking for any signs or symptoms that they are present.

A full anatomical inspection of your penis is often the first place your doctor may start; there are certain conditions which can affect the size, shape and angle of the penis which could have a bearing on your ability to develop and maintain an erection.

Your doctor will probably need to take some blood too; this is to check for hormone imbalances which could be the underlying cause. For example, in hypogonadism, insufficient testosterone is produced, which in turn prevents the body from produces the prompts necessary to create a usable erection.

Rectal examination

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For men aged over 50, you may also be asked to consent to a DRE – a digital rectal examination. This involves a gloved finger being inserted into your back passage so that the doctor can feel your prostate gland. Older men are more prone to have problems with their prostate, including everything from simple enlargement through to prostate cancer, and erectile dysfunction can be one of the giveaway signs of this.

If you are younger and having problems with erectile dysfunction which are thought to have a physical rather than psychological cause, you may be asked to go and see and expert in order to have further tests.

Cardiovascular signs

Erections are created when an increased amount of blood flow is delivered to the penis, swelling and hardening the tissue.

It therefore makes sense that any disease which either reduces the capacity of the circulatory system or the ability of the arteries to dilate and allow more blood to enter the penis could be the cause of impotence.

Cardiovascular disease is one of the most common underlying cases for impotence but you may not be aware that you have it. Often impotence is one of the first signs that there is something wrong.

Your doctor will therefore carry out some tests to see if you have undiagnosed cardiovascular disease. If you are found to have it, there’s a very good chance that this is the reason you are suffering from erectile problems.

Your blood pressure will be checked, and the doctor will listen to your heart, to try and detect any abnormalities with either the rate or the actual rhythm. Obesity is another contributing factor so your height, weight and waist measurements will be taken. Individuals who carry more weight around their middle are at a much higher risk of developing cardiovascular disease than if the weight was distributed elsewhere.

Blood pressure check

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You will be asked to describe your lifestyle to the doctor, including the kind of food you eat and how much exercise you take. Even if you aren’t overweight having a poor diet and not taking regular exercise can lead to cardiovascular disease.

When you provided a blood sample, you will be asked to refrain from eating for a 12 hour period before. This is so that the doctor can check the amount of cholesterol you have in your blood as well as assess your blood glucose (sugar) levels. This latter test is how to check for diabetes, a disease which if left controlled and untreated can lead to cardiovascular disease.

More extensive tests

In some cases your doctor will decide that more complex tests need to be carried out in order to see whether you have any physical factors causing your impotence.

If there’s any suggestion that there might be a problem with the flow of blood into your penis, or the supply of blood to the area, you may undergo a test known as an intracavernous injection test.

This involves a special kind of injection directly into the penis, a synthetic hormone. This hormone should increase blood flow to the area, resulting in an erection. If an erection can’t be achieved it is a strong sign that the blood flow to the penis is being restricted in some way. However, even if the results do produce an erection, it’s still possible that you have a problem with your blood vessels. The only way to be absolutely certain is to carry out an ultrasound; this looks in more depth at your arteries and will allow the doctors to see your artery walls and blood vessels far more clearly.

There is another test which can be carried out which involves a special kind of dye being injected directly into the blood vessels in the penis, and then taking a closer look using a type of scanner. This test is normally reserved for this where it’s strangle expected that your impotence is either attributable to abnormalities in the blood vessels in the penis or if you are considering having surgery.

Psychological assessment

In addition to all the tests which can be carried out to detect any physical signs or symptoms of impotence, there’s also a number of checks which can be carried out to see if there’s any indication you are depressed, or have any other mental health conditions.

A lack of energy is a possible cause of impotence

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There are a number of different types of scales which doctors can use to objectively see whether you are showing any clinical signs of depression or anxiety. However, any individual who is depressed may well present with some of the following symptoms:

loss of interest in activities which were previously enjoyable

feeling that you are helpless to take action

having a bleak view of the future

having a shorter fuse than normal or being irritated

difficulties with sleeping patterns – either sleeping too much or too little

lack of energy

feelings of worthlessness

being withdrawn in their personal relationships 

no patience

difficulty in concentration or focusing on even simple tasks

indulging in unusual behaviour such as being particularly reckless

an increase in physical pains or problems, such as impotence, back pain, stomach ache and headaches

These are some of the classic signs of depression and other related conditions and when impotence is being triggered by a psychological cause, some of these symptoms may well be present.

However, mental health issues in men can sometimes be more difficult to spot because they are conditioned to internalise how they are feeling rather than express themselves freely.

For this reason, other behaviours which don’t always immediately suggest a mental health problem may be present; this is just a disguise for depression.

Some of the alternative types of symptoms you might see in men include an increase in aggression, the need to dominate and remain in control at all times, blaming others around them for problems, guarded behaviour and argumentative. You may also notice abuse of substances such as alcohol or tobacco, or obsessive behaviours about sports or TV.

Men who suffer from impotence are twice as likely to show symptoms of depression, but it can be difficult to ascertain which came first. Did depression cause the impotence or has it arisen as a result of the erectile dysfunction? Unpicking the sequence of events and getting to the root cause can be extremely difficult.

Depression could be a contributory cause to your impotence

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Medication can help treat the symptoms of depression very effectively but when coupled with impotence it can be far less straight forward. Some antidepressants can cause impotence as a side effect, rendering these drugs unsuitable for use.

By treating the symptoms of depression with a drug which should not interfere with sexual function can help to pinpoint whether the psychological factors were present before or after the impotence.

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