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Tests for Erection Problems

Stamp Test (for Erection Problems), Erection Problems Tests, Rigidity Test (for Erection Problems), Intracavernosal Injection Test, Nocturnal Penile Tumescence Test

There are certain tests for erection problems which can help establish the cause of a man's erection problem - difficulty in having or maintaining an erection - also known as erectile dysfunction or impotence.

Erectile dysfunction is a common enough male problem. Most erection problems are the result of a combination of blood vessel, nerve, or psychological problems. Compare that to delayed ejaculation treatment where we know that treatment can be effective!

Physical issues that may cause erection problems include:

Problems with the nerves inside and running to the penis

Conditions such as diabetes and multiple sclerosis may produce nerve damage which affects your ability to develop and keep an erection. Surgery, many injuries, and cancer radiation treatment to the pelvic area may cause some damage to the nerves running to the penis. Problems with those small blood vessels which supply blood to the penis can be a cause of erection problems.

For example, hardening of the arteries - also known as atherosclerosis - may make it challenging for a man to have an erection. Less well known is the fact that long-distance bicycle riding on a hard, narrow racing bike saddle may increase a man's chance of having an erection problem due to damage to the blood vessels leading to his penis. Low levels of male hormones, such as testosterone, or even thyroid hormones can produce erection problems.

And so can side effects of medicines for high blood pressure (hypertension) or depression. Last but not least, the use of tobacco, alcohol, or illegal drugs can cause an erection problem.

Psychological intervention may be needed if no physical origin is found for an erection problem.

Psychological causes of erection problems can include:

Anxiety about sexual performance; stress; depression; grief; relationship problems.

Tests for erection problems will involve a sexual history and and possibly a physical examination. A physical examination may well involve checking your blood pressure. Needless to say, your penis and testicles will certainly be checked for any problems.

And a competent doctor will order blood tests for testosterone, luteinizing hormone (LH), thyroid hormones and prolactin.

Other possible blood tests include a blood check for glucose, cholesterol, and triglyceride. Depending on the results of these tests, many if not most doctors will have you try sildenafil citrate (Viagra), vardenafil (Levitra) or tadalafil (Cialis) at this point.

Other possible tests for erection problems are a nocturnal penile tumescence (NPT) test or an intracavernosal injection test.

Nocturnal penile tumescence (NPT) test

The NPT test  is also known as the stamp test or the rigidity test.

Most men have between 3 and 5 full erections during deep (that is during the rapid eye movement or REM) sleep. The key point is that men who do not have erections due to some psychological problem or other will still have full erections during deep sleep. Nocturnal erections are a good indicator of normal erectile function. The NPT checks if a man is having normal erections during sleep.

This test can be done at home with a snap gauge made up of brittle plastic films around the penis. The film snap at certain pressures, caused by an erection during sleep. For more sophistication but no greater accuracy, an electronic monitoring device will give detailed information about nocturnal erections - how long they lasted, how many of them there were.

Tests are usually done two nights in a row. If good, healthy erections occur during REM sleep, then psychological causes must be examined.

Intracavernosal injection test for erection problems

During this test, the doctor injects prostaglandin E1 into the base of the penis to induce an erection. This  intracavernosal injection may also be placed as a pellet into the urethra. This is an intraurethral injection. The fullness of the erection and its duration is measured.

Doppler ultrasound test for erection problems

Doppler ultrasound  - or colour duplex Doppler - uses a hand-held machine passed lightly over the penis. This modern tool uses reflected sound waves to calculate the speed and direction of blood as it flows through the small vessels inside the penis. The sound waves are converted by a PC into colors that are overlaid on a diagram of the penis blood vessels. This shows the speed, volume and direction of blood flow.

Why treat an erection problem?

The decision about treatment of an erection problem may not be simple because while an erection problem is not life-threatening, it can seriously affect your sexual emotional health and self-esteem. It can also make it get your partner pregnant. The decision about treatment is often based on personal choice. Of course, the other factor is how intensive or invasive the treatment is and how well it may work.  Injecting medication into the penis is often very effective, but it is usually only a last resort after Viagra, Levitra, or Cialis have been tried.

Try MUSE (medicated urethral system for erections), a tiny pellet of alprostadil (prostaglandin E1) is inserted into the opening of the urethra. A thin applicator contains the pellet of medication, which is pushed into the opening of the penis. The pellet is released into the penile urethra.

Inject medication into the side of the shaft of the penis. This medication includes phentolamine mesylate (Regitine), alprostadil (Caverject), and papaverine hydrochloride (Pavabid).

You may of course wish to try counseling or sex therapy as described on this website.

You may also wish to give up intercourse and seek other ways to express your sexuality.

The decision about whether to use injections or pellets to treat your erection problems may be helped by the following table:

Medications for erection problems


Medication Reasons to use for an erection problem Reasons not to use for an erection problem
MUSE One to two thirds of men using MUSE get an erection sufficient for intercourse. You will find that your erection develops in about 10 minutes and lasts for half an hour or so.

MUSE does not cause bruising or scar tissue (injections can do this).

Side effects include pain which can be quite severe and mild injury to the urethra during application, such as a graze which causes a small drop of blood. There may also be some irritation to a man's partner's vagina when he ejaculates. You must avoid oral sex without a condom.
Injections into the side of penile shaft Up to 90% of men using this method achieve erections good enough for sexual intercourse. Erection lasts half an hour or more. Dose can be adjusted to suit the individual. Auto-injector can be made available if unable to give standard injections. Side effects include:

Risk of bruising and Peyronie's through scar tissue formation. You may get some pain in the penis. Formation of scar tissue can occur in the penis (fibrosis).

Following are some points about injections or pellets for an erection problem.

Considerations about medications for erection problems


Reasons to consider injections or pellets for an erection problem Reasons not to consider injections or pellets for an erection problem
Enhanced self-esteem because you can have sexual intercourse.

You are able to have children.

You can make love.

It is a repulsive idea to inject into the opening or side of the penis.

Lack of spontaneity during lovemaking.

These methods are less effective in men with impaired blood flow into or out of the penis.

Injecting may be difficult for men who have vision problems.

Fred and Maggie: When Fred was having trouble keeping an erection, we discussed it and decided we wanted to have intercourse, so we tried Viagra, but it didn't work. The doctor suggested MUSE but we found we could enjoy a sexual relationship without intercourse, and because we did not want to inject anything Fred's penis, made us choose Viagra.

Dave and Helen: My erection problems had been causing problems between us so we were excited about Viagra - but alas, it did not work! Injections are inconvenient, but sex is still important to us and when Viagra didn't work, we were very disappointed and asked our family doctor what else could be done and he suggested injections but what we find is that stopping our lovemaking to inject my penis spoils the flow. We wanted to find a psychotherapy way of dealing with erection problems, and we found it on this website.

Michael and June: I was having trouble getting a good erection, and my erection problems were affecting my relationship. I cannot use Viagra. June and I wanted to see if there was something we could do so we looked at the advantages and disadvantages of injections and decided to use psychotherapy to deal with erection problems instead. 

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