Psychological and/or psychiatric referrals: May provide important complementary insight into relationships and situational causes of ED. These assessments do not form a routine component of the ED workup and should be considered in the unusual case.
Vascular testing: A variety of vascular tests exist. Historically, a penile brachial index (PBI) assessment was used. The PBI is a noninvasive test that records penile pressure as an index of arm pressure, providing a rough idea of the penile circulation. buy ortho tri-cyclen online
The availability of a duplex scan is common. The ultrasound scanner localizes and measures the flow through the cavernous vessels, before and after vasoactive injection, and allows a more refined assessment of the penile circulation.
The dynamic infusion cavernosometry and cavernosog-raphy measure the rise and fall of intrapenile pressure with radiological visualization of the veins draining the penis to determine whether there is a competent veno-occlusive mechanism.
The penile angiogram is reserved for cases of high-flow priapism or planned vascular bypass. This test allows visualization of the penile circulation and directs embolization for the unusual cases of penile injury-induced, high-flow priapism.
Endocrinological tests: There is controversy about what is the ideal endocrine workup for men with ED. Testing for morning total testosterone, or bioavailable testosterone, is logical in cases in which sexual interest or significant reduction in ejaculate volume are present. Free testosterone measurement may have significant intra-assay variability, which may limit its clinical utility.
Neurophysiological testing: This form of testing generally allows for measurement of the sacral reflex arc – an indirect measure of the perineal neural integrity.