Erectile dysfunction: be prepared for your urologist visit

Going to see a urologist about erectile dysfunction? Read this first so you know what to expect.

Erectile dysfunction (ED) may be a source of embarrassment for some men, but you should never ignore it. Aside from affecting your quality of life, it can also be a sign of a bigger health problem. If you’re still hesitant about the idea of visiting a urologist, the more you know, the more at ease you’ll be on the day.

You can see a urologist without a referral

You don’t need a referral from your GP to visit a urologist. However, Dr Mike Bolus, a urologist at Mediclinic Vergelegen in Somerset West, recommends chatting with your GP first – especially if you’re more comfortable seeing someone you know about ED. “Some GPs have a special interest in urology, while others would immediately refer, so it’s worth calling and checking,” he says.

Be ready to share some intimate info

While you won’t have to disclose your full sexual history, the doctor will ask some pretty personal questions and it’s a good idea to be ready for them, says Dr Bolus. You can expect questions about:

• Time frame – how long you’ve been experiencing ED.
• Symptoms – are you struggling with rigidity? Keeping an erection? Do you still have spontaneous erections, for example, at night? Is early ejaculation a problem for you? How is your libido?
• Confidence levels – in some cases, ED is linked to stress, fatigue or anxiety.
• Urination – the urologist may ask about the stream, pattern and if you’re frequently getting up at night to use the bathroom. It may not seem relevant, but could provide clues that you have an underlying condition, such as an enlarged prostate.
• Medical history and family history – the urologist will be looking out for conditions such as hypertension, high cholesterol, diabetes and smoking. “In a significant number of cases, ED is just one part of a bigger issue,” says Dr Bolus.
• Exercise tolerance – if you’re struggling to get fit, it could be a sign of a cardiovascular problem. Dr Bolus says he often refers patients to a cardiologist to rule out the possibility of undiagnosed heart disease.
• Medication – certain medicines, such as antidepressants, antihistamines and for hypertension, may contribute to ED.

Hands-on physical examination

“Patients need to know that this will be a full urological exam – they’re not just going to have a chat,” says Dr Bolus. The physical part of the ED exam includes:

• Blood pressure – but if you know you get nervous due to “white coat syndrome”, Dr Bolus advises having this done at a pharmacy for a more accurate reading.
• Chest exam – enlarged breast tissue (yes, men have it, too) can indicate low testosterone levels.
• Urogenital exam – shrunken testes can be another sign of low testosterone levels; the doctor will also examine the penile tissue.
• Prostate exam – including an ultrasound to check the size and condition of the prostate.
• Urine tests – check the flow, and test for signs of diabetes and other abnormalities.
• Blood tests ­– check testosterone levels and, possibly, cholesterol, glucose and prostate-specific antigen (PSA).

Arrive prepared

Dr Bolus recommends booking an early-morning appointment if possible, as testosterone levels are best tested before 10am. Arrive with a full bladder for the urine tests and ultrasound and bring a list of any medication you’re taking – this includes recreational drugs and alcohol use. It excludes supplements, as they generally don’t cause ED, but if you’re concerned about anything, put it on the list.

Treatment options

If you’re experiencing ED because of an underlying health issue, such as diabetes or hypertension, your GP or specialist will help you manage that condition. In addition to treating the underlying medical condition, there are also specific treatments for ED, including PDE inhibitor drugs like Viagra and Cialis – although these often have cold-like side-effects, which will influence dosage. If those don’t work or you can’t use them due to, say, a heart condition, the urologist may recommend injections of vasodilators directly into the penis or using a vacuum device.

ED may be an uncomfortable topic, but with the help of a urologist, it can often be treated – so the sooner you make an appointment, the better!