the history in erectile dysfunction

Last reviewed 01/2018

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)