The Diagnostic Three-Team Approach of the Male Patient with Sexual Dysfunction for Evaluation of the Organic versus Psychogenic Erectile Disorder, Emphasis Given to Investigate the Percentage of Vascular, Neurologic, Endocrine and Psychogenic Involvement of the Organic Pathology

In the assessment of the patient with erectile dysfunction, psychogenic and organic (vascular, neurological and endocrine) involvement should be considered in the pathogenesis of the condition. The possibility of erectile dysfunction being of mixed origin, complicates the diagnostic approach even further. An integrated team approach of different specialists is required. In our Sex Institute, every patient with erectile dysfunction has been evaluated separately by a psychologist, an endocrinologist and a urologist. Psychological assessment consisted of an expert’s interview, taking into consideration the patients’ complains, in many instances the partner’s complains and the psychologist’s observations. Endocrinological evaluation consisted of a detailed medical history and a complete physical examination complemented with various general and endocrine hematological tests as required. Urological evaluation consisted of an initial interview, a physical examination according to the complains, especially rectal and scrotal examination, followed by testing the vascular system usually with a papaverine test. Rigiscan and PSA levels were used as required. All patients after the three diagnostic team approach had an extended meeting with all three specialists present, in order to discuss the involvement of each side in the pathogenesis of their erectile dysfunction. Thus the percentage of the contribution of each side was rated. Erectile dysfunction is multifactorial and diagnostic accuracy is highly desirable. We therefore conclude that this team approach, guarantees the in depth diagnostic evaluation of erectile dysfunction in all patients attending the Sex Institute, while a definite diagnosis is obtained in most cases. Introduction Erectile dysfunction is a common symptom affecting millions of men worldwide [1, 2] and efforts are being taken in order to investigate the true incidence worldwide [3]. Extensive studies in various countries are taking place [4] particularly in view of the current use of new medications for treatment [5, 6]. Erectile dysfunction, although common, is of variable aetiology [7, 8]. Organic, psychogenic and social factors are involved in the aetiology and all these should be taken into consideration for the correct diagnosis to be obtained. Organic factors can be vascular, neurological and endocrine, psychogenic and social can also be multiple [9, 10]. A clinical approach to the erectile dysfunction patient should take all the above factors into consideration [9]. Correct diagnosis, guarantees appropriate treatment and when the suggested treatment is successful, there is often improvement and cure of the symptoms together with amelioration in the relationship (s) and patients’ levels of stress, mood and self esteem. A single clinician is usually not effective in such a broad spectrum approach, since it requires surgical/urological/medical and psychological expertise. Many aspects of the problem that could have been omitted or missed by one clinician are usually successfully covered by the other. In the Athens Medical Sex Institute we used a multidimensional clinical evaluation by a three team approach in order to correctly diagnosing the aetiology of erectile dysfunction in male patients. Initially this claims to differentiate the organic versus psychogenic aetiology. After this is achieved with minimal investigations required, emphasis is given to investigate the percentage of vascular, neurologic, endocrine and psychogenic involvement in the organic erectile dysfunction. We describe here our integrated team approach to the diagnostic evaluation of the erectile dysfunction patient. WebmedCentral > Industry Sponsored Research Page 2 of 7 WMC003848 Downloaded from http://www.webmedcentral.com on 23-Nov-2012, 04:36:14 PM