• History and clinical questioning (this is the most important component of the ED evaluation).
• A focused physical examination (directed at neural and vascular systems essential for achieving and maintaining erections).
• Questionnaires (eg, International Index of Erectile Function, Sexual Health Inventory for Men [Appendix 1]).
• Laboratory tests, including serum glucose, hormonal screening (total testosterone or bioavailable testosterone) and lipid screening. buy ampicillin
• Specialized tests
– In-office intracavernous injections
– Duplex ultrasound with vasoactive penile injection
– Dynamic infusion cavernosography and cavernosometry
– Penile angiogram Treatment choices
• Sexual counselling (This may represent a spectrum of approaches, from a simple open discussion with the PCP to sexual therapists or psychiatry experts in intimacy-building and sensate focus therapy.)
• Oral therapy (PDE-5i) or hormonal supplementation, if required
• Vacuum device
• Local therapy (intraurethral or intracaverous agents)
– Penile implant
– Surgical repair for Peyronie’s disease
• Vascular bypass procedure (generally reserved for young men following traumatic penile vascular injury