The first step in evaluating ED is a detailed medical and sexological history of patients and partners
It is important to establish a relaxed atmosphere during history-taking. The following should be included during initial assessment:
- sexual history - a detailed description of the problem, including
- onset and duration of the erectile problem
- previous consultations and treatments
- the rigidity and duration of both sexually stimulated and morning erections
- problems with arousal, ejaculation, and orgasm
- current relationship status, contextual threats "If this doesn't get better in two weeks I'm leaving", history of previous sexual partners and relationships
- issues of sexual orientation and gender identity
- lifestyle factors e.g. - cigarette smoking, a sedentary lifestyle, recreational drugs
- concurrent medical history e.g. - diabetes, cardiovascular disease, and lower urinary tract symptoms etc.
Differentiating between psychogenic and organic erectile dysfunction
- history suggesting organic causes includes:
- gradual, insidious onset with progressive worsening until no erection is obtained
- present in all situations e.g. - during attempted intercourse with his regular or another partner, masturbation or in response to erotic stimuli
- markedly diminished nocturnal erections and absence of morning erections
- risk factor in medical history (cardiovascular, endocrine or neurological)
- operations, radiotherapy, or trauma to the pelvis or scrotum
- use of drugs associated with erectile dysfunction
- cigarette smoking, a sedentary lifestyle, recreational drugs
- history suggesting psychogenic causes includes:
- patients are often younger, with no identifiable medical risk factors
- have an abrupt onset
- may recall a specific time when the problem began (such as relationship breakdown, start of intimacy with a new partner)
- nocturnal and early morning erections is generally preserved
- erections being maintained during masturbation and being adequate for intercourse with a different partner (1,2,3)
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