At the first presentation in the andrological consultation or practice, the patient should first be asked about the duration and extent of erectile dysfunction as part of the sexual anamnesis. The question about the duration of erectile dysfunction already allows a classification into primary and secondary disorders. The very rare primary erectile dysfunctions are present from puberty on and are found especially in vascular malformations. Usually, however, secondary erectile dysfunction is present, i.e., the disorder occurs only after an interval of normal sexual activity. The nature and extent of erectile dysfunction are more closely characterized by the question of acute, episodic, or a chronic occurrence in that the latter is more suggestive of organogenesis, whereas act-related (only during sexual intercourse, not during masturbation), partner-related (only with the wife, not with the girlfriend), and situation-related (unfavorable living conditions) erectile dysfunction are more suggestive of a nonorganic cause [1]. It should be clarified whether it is a primary libido or erectile dysfunction or a combination of both. Limb rigidity during sexual intercourse or the attempt and duration of erection should be inquired. Thus, premature erection loss immediately after penetration can be found in psychogenic disorders, but also in the so-called venous leak. Premature ejaculation (ejaculatio praecox) with undisturbed erection, on the other hand, is generally psychogenic in nature. Painful ejaculation indicates prostatovesiculitis and requires further diagnostic measures (urine after rectal palpation, ejaculate culture if necessary). Questions about bending of the penis during erection provide information about the presence of genital anomalies or diseases in the sense of induratio penis plastica. Good spontaneous limb rigidity early in the morning or at night also indicates intact organ physiology. The sexual history is rounded off by the question about the current partnership situation and the quality of the same, as well as the satisfaction with the current life situation. Table 2.1 provides an overview of the sexual history.
Table 2.1 Sexual history
The general medical history should include questions about diseases of the liver, thyroid, kidneys, adrenal glands, central nervous system, and cardiovascular system, all of which may be causally involved in erectile dysfunction. In the case of hepatic insufficiency, accumulation of exogenous non-steroidal estrogens through insufficient metabolism is thought to contribute causally to the potency disorder [3]. Upper and lower thyroid dysfunction, but especially thyrotoxicosis, may be linked to sexual dysfunction [2]. Among adrenal disorders, Cushing's syndrome and Addison's disease can lead to erectile dysfunction through Leydig cell dysfunction [2]. Feminizing adrenocortical tumors must also be considered. Erectile dysfunction may also be a common accompanying symptom in chronic renal failure, although the cause is not fully understood [2]. CNS disorders are discussed in Chap.5 (neurologic examination). In cardiovascular and vascular diseases, the arterial risk factors like hypertension, hyperlipidemia, hyperuricemia, diabetes mellitus and nicotine abuse should be recorded. Virag [4] demonstrated that a combination of 2 or more risk factors correlates to arterial erectile dysfunction. Micturition problems should be investigated, as bladder voiding dysfunction may be the first sign of a vegetative neuropathy, e.g., diabetic neuropathy. The use of medications is becoming increasingly important. The negative influence of many preparations on erectile function is not generally known (cf. chapter 1). Furthermore, chronic intoxication by alcohol, tranquilizers, barbiturates, opiates, cocaine as well as by industrial poisons, e.g., lead and hydrocarbons, impair erection. In addition to hepatic insufficiency, polyneuropathy is a possible cause of erectile dysfunction in alcohol abuse (Table 2.2). Surgical procedures in the pelvic region (Table 2.3), radiation therapy and trauma to the genital organs can also be the cause of erectile impotence.
Table 2.2. General history.
Table 2.3. Operations with possible negative effect on erection.
The anamnesis is divided into a general anamnesis and a sexual anamnesis. During the interview, the first indications of an etiological assignment of the complaints are obtained. At the same time, the basis for doctor-patient cooperation is established, which is important for the further diagnostic process. Tables 2.1–2.3 provide an overview of significant anamnestic data.
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