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Algorithm for the diagnosis and treatment of erectile dysfunction. Algorithm for the diagnosis and treatment of erectile dysfunction. Additional Testing in the Workup of Erectile Dysfunction. Laboratory investigations (complete blood count; free testosterone, luteinizing hormone, and prolactin levels; sex hormone-binding globulin test; urinalysis) Psychological or psychiatric consultation. Neurophysiologic testing (vibrometry; bulbocavernosus reflex latency; cavernosal electromyography; somatosensory evoked potential test; pudendal and sphincter electromyography) Nocturnal penile tumescence and rigidity assessment. Specialized endocrinologic testing (hypothalamic-pituitary-gonadal function studies; magnetic resonance imaging of the sella turcica) Vascular diagnostics (duplex ultrasonography; penile pharmacocavernosometry and pharmacocavernosography; penile arteriography; computed tomography or magnetic resonance imaging; nuclear imaging) Adapted with permission from Jardin A, Wagner G, Khoury S, et al. Recommendations of the 1st International Consultation on Erectile Dysfunction. Plymouth, U.K.: Health Publication Ltd, 2000:718–719 . Additional Testing in the Workup of Erectile Dysfunction. Laboratory investigations (complete blood count; free testosterone, luteinizing hormone, and prolactin levels; sex hormone-binding globulin test; urinalysis) Psychological or psychiatric consultation. Neurophysiologic testing (vibrometry; bulbocavernosus reflex latency; cavernosal electromyography; somatosensory evoked potential test; pudendal and sphincter electromyography) Nocturnal penile tumescence and rigidity assessment. Specialized endocrinologic testing ... More

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The nerves in those neurovascular bundles are also responsible for nighttime erections (in your sleep), and those “are responsible for penile health and strength.” Think of tiny push-ups happening in your sleep. After surgery – temporarily if one or both nerve bundles (the nerves to the penis) are spared – these erections don’t happen. If these bundles are damaged or removed during surgery, scar tissue can develop. When any part of the body is injured, a scar forms. This is because as it heals, tissue gets fibrosis (it hardens; this is the more rigid tissue that makes up a scar). There is extra collagen in there, and this contracts over time. This contraction can shrink the penis by as much as half an inch. I’d rather have the cancer!” or make any hasty decisions, please read this next sentence: “The good news is that there is a way to prevent the loss of length in the penis: using a vacuum erection device,” Bivalacqua says. Please note this important point: We’re focusing on stretching, not shrinking. Briefly, the VED is what you might suspect; an actual vacuum. The device costs between $200 and $500, and is available from the pharmacy with a prescription. You place a clear plastic cylinder over the penis, and use either a manual or electrical pump to create negative air pressure (a vacuum). It takes about two minutes to achieve an erection; then you slip a flexible tension ring from the bottom of the cylinder around the base of the penis. “No matter what is specifically causing the erection, the vacuum causes the vessels in the penis to fill with blood, just as they would during a normal erection.” There’s a downside, though: “The big complaint of all men using the ... More

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