Blood Investigations

Order blood investigations depending on your findings. In our clinic, men are offered tests for fasting glucose; prolactin levels; high density lipoprotein ratio and triglycerides; a 9 am testosterone, SHBG and free androgen index. Other specific tests may be appropriate (e.g., LH and free testosterone; TSH).

Some centers are able to offer further investigations. To assess erectile function, nocturnal penile tumescence (NPT) can be assessed using strain gauges. However, rigidity is seen as an important factor for assessment and tumescence and rigidity can be assessed using the Rigiscan monitor. This device is involved in both provocative testing of erectile response in the clinic or laboratory as well as home nocturnal testing. The patient can take the device home for nocturnal testing after receiving some tuition on its use. Rigiscan can be used to investigate suspected cases of neurological or psychological causes (20). Another device, the NEVA (nocturnal electronic volumetric assessment) is worn while asleep at home and is of particular use in the investigation of vascular disorders.

Erectile capacity can be undertaken by observing the response to an intra-cavernous injection of alprostadil or papaverine. This can be quantified by the use of Doppler ultrasound and undertaken in the hospital setting. Other stimuli such as vibration and erotic videotape material may be helpful to augment the response, particularly in the clinical setting. The MIDUS (Male Impotence Diagnostic Ultrasound System) is a Doppler machine that is used in clinics to measure penile blood flow. Unlike Duplex Doppler Ultrasonography performed in the hospital, the Knoll/MIDUS Ultrasound System is designed as an office-based system. Doppler Duplex sonography will allow for visualization of the vascula-ture in patients eligible for reconstructive surgery.

Electrophysiological testing may be indicated in specific cases [e.g., nerve conduction studies, GSA (genital sensory analyzer)].

A consensus statement of recommendations has been published following the second international consultation on sexual dysfunction (21).

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