IMPOTENCE
Ask the Following Questions:
- Is there a history of alcohol or drug ingestion? A host of antihypertensive drugs, including the beta-blockers, may cause impotence. In addition, tricyclic drugs, nicotine, and alcohol intoxication may cause impotence.
- Is there loss of secondary sex characteristics? These findings suggest Fröhlich's syndrome,
Klinefelter's syndrome, and other congenital disorders.
- Are there abnormalities on urologic examination? Various conditions such as Peyronie's disease, atrophied testes, prostatitis, and Leriche's syndrome may be found on urologic examination.
- Are there abnormalities on the neurologic examination? Neurologic examination may reveal diabetic neuropathy, spinal cord tumor, multiple sclerosis, and other neurologic disorders.
DIAGNOSTIC WORKUP
A thorough psychiatric and sexual history is necessary before undertaking expensive laboratory tests. It is wise to interview the spouse or sexual partner also because the symptom may be exaggerated by the patient. Do not hesitate to order a drug screen. Routine tests include a CBC and differential count, a urinalysis, a urine culture and colony count, a chemistry panel, VDRL test, thyroid profile, serum testosterone, and gonadotrophin assay. A referral to a urologist is probably wise at this point. He will work up the patient further with a nocturnal tumescent study, Doppler ultrasonography, and penile blood pressure studies. In addition, he may want to do a cystoscopy. It may be wise to perform a postage stamp test before referral for a formal tumescence study.
Nerve conduction velocity studies and EMGs may be needed to rule out diabetic neuropathy. MRI of the spine, cystometric studies, and SSEP studies will help to rule out multiple sclerosis and other spinal cord lesions. A sacral reflex latency time may be very helpful in diagnosing sacral nerve injury. A spinal tap may help rule out central nervous system lues. Angiography may be needed to exclude a Leriche's syndrome.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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