Patient's question:
I have always been in good health, and our marital life has also been harmonious. However, in the past six months, due to high work pressure, I have always felt very tired, and in terms of sexual life, I often couldn't get an erection or had insufficient erection strength. As a result, my relationship with my wife has been greatly affected.Doctor's answer:
1. Examination of the genitalia, including the contents of the scrotum, and the examination of secondary sexual characteristics to assess whether physical and sexual development is normal and whether there are any congenital anatomical abnormalities that obstruct sexual activity.2. A complete physical examination to identify systemic diseases that may affect sexual function. For example, certain diseases can be detected through skin manifestations, such as spider angiomas indicating liver disease or hyperpigmentation in Addison's disease. Eye examinations can reveal conditions like exophthalmos in hyperthyroidism, Argyll Robertson pupils in neurosyphilis, or diabetic retinopathy. Nerve and vascular damage often accompanies sexual dysfunction, making these examinations essential. This includes tests for reflexes, coordination, motor and sensory function, strength, skin temperature, and palpation and auscultation of peripheral pulses.
3. Laboratory and other special examinations should be conducted for suspected organic causes of sexual dysfunction, particularly in cases of erectile dysfunction and low libido, in combination with medical history. The following targeted tests are recommended:
(1) Endocrine disorders testing: Diabetes is associated with a 50% incidence of erectile dysfunction, so blood glucose and glucose tolerance tests are often included as routine. Serum testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels can reveal hypothalamic-pituitary-gonadal axis dysfunction.
(2) Vascular disease testing: Non-invasive penile blood pressure measurements can be performed using digital plethysmography and handheld Doppler devices. Penile temperature measurements provide indirect evidence of arterial circulation. Pelvic radionuclide scans can assess local blood flow and changes due to activity or medication. Pelvic and perineal angiography, as well as penile cavernosography, can determine the location of obstructions, the extent of collateral circulation, and venous.