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How is ED diagnosed?

Patient History

A person's medical and sexual histories help define the degree and nature of ED. The medical history can disclose diseases that lead to ED, and a simple recounting of sexual activity might identify problems with sexual desire, erection, ejaculation, or orgasm.

Use of certain prescription or illegal drugs can suggest a chemical cause because drug effects are a frequent cause of ED.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to physical touch, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as unusual hair pattern or breast enlargement, can point to hormonal problems, which would mean the endocrine system is involved. The doctor might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem-for example, a penis that bends or curves when erect could be the result of Peyronie’s disease.

Laboratory Tests

Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of available testosterone in the blood can yield information about problems with the endocrine system and may explain why a patient has decreased sexual desire.

Other Tests

Monitoring erections that occur during sleep-nocturnal erections-can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than a psychological cause. Tests for nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be conducted for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, can reveal psychological factors. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

Surgery For ED

Surgery usually has one of three goals:

• to implant a device that can cause the penis to become erect
• to reconstruct arteries to increase blood flow to the penis
• to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with ED.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see Figure 3). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. The pump causes fluid to flow from a reservoir residing in the lower pelvis to two cylinders residing in the penis. Inflatable implants can expand the length and width of the penis to some degree. They also leave the penis in a more natural state than malleable implants do when not inflated.

Once a man has either a malleable or inflatable implant, he must use the device to have an erection. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have decreased in recent years because of technological advances.

With an inflatable implant, an erection is produced by squeezing a small pump implanted in the scrotum. The cylinders expand to create the erection.

Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the groin or fracture of the pelvis. The procedure is usually unsuccessful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure-intentional blockage. Blocking off veins, called ligation, can reduce the leakage of blood that diminishes the rigidity of the penis during an erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

Erectile Dysfunction Pathophysiology

Penile erection is managed by two different mechanisms. The first one is the reflex erection, which is achieved by directly touching the penile shaft. The second is the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.

Multiple Female Orgasms

Women are able to experience multiple orgasms which can be serial. Multiple meaning they are experiencing several orgasms immediately one after another or sequential multiple orgasms, which are the orgasms that occur one after another but separated by few minutes. Even though multiple orgasms are very rarely experienced, they are not impossible. They are, in opinion, the ultimate climax women can achieve.

Women are able to achieve multiple orgasms due to the fact that they do not require any kind of refractory period as men do after the first orgasm. Theoretically, if stimulation is not interrupted, most women should be able to achieve multiple orgasms. Achieving multiple orgasms is not as easy as it looks given that generally women reach orgasms with greater difficulty than men. The variety of erogenous zones that a woman has on her body and that can be stimulated are an advantage that women have and men do not. For some women, the most sensitive area in the body is the G-spot, while for others, it is the Clitoris. If properly stimulated, the G-spot may cause very strong orgasms, some stronger than the ones reached after clitoral stimulation. The G-spot's existence is still under dispute, as its location and size varies from woman to woman, or appears to be nonexistent in some women.

During heterosexual intercourse, it is common that men stop the stimulation process in a woman (after experiencing orgasm themselves, and losing their erection), and this may be one of the reasons why many women do not actually achieve more than one orgasm. However, some women do not want to be pressured into another orgasm while others are eager for more, as the stimulation can be overwhelming or painful. Sometimes, female multiple orgasms are accompanied by female ejaculation. There is one important difference between male and female multiple orgasms which is also the reason why men cannot ejaculate when they experience a multiple orgasm. Although the biological function of a woman's orgasm is not completely understood as it does not serve an essential purpose to human survival some theories suggest that muscular contractions associated with orgasms pull sperm from the vagina to the cervix, where it is in a better position to reach the egg.

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Acting audition

An acting audition is used in the casting process to demonstrate the level and range of a performer's talent, and functions as well as finding the right actor for the work written. For actors, the audition piece is typically not from the show being considered. Some auditions involve cold reading, or performing a script that the actor is not familiar with. An actor may be called back multiple times during an acting audition for a certain role. Any actor knows that in order to build a career and to start landing paying jobs, you have to audition. Visit auditions to find out everything you need to know about auditioning. An acting audition is an interview for a role in a performance for TV, film, commercials or theatre.

Acting auditions are used in the casting process to demonstrate the level and range of a performer's talent. Some auditions involve cold reading, or performing a scene from sides (pages from a script) that the actor is given in advance or when arriving at the audition. An actor may be called back multiple times during an acting audition for a certain role. Acting auditions are a large part of any actors' career and will be for many years. Any additional information an actor has regarding the audition process can only help. To get more information about auditions, go to audition.