Urologists treat conditions that affect the urinary tract and male reproductive organs, including erectile dysfunction (ED). They can perform tests to determine the cause of the condition and recommend treatments.
According to BMJ Journals, ED is one of the most common conditions among middle-aged and older males. In this article, we look in more detail at what urologists can do for ED, how to find a urologist, and the treatments a urologist may recommend.
Urologists specialize in treating conditions that affect the urinary tract and the male reproductive system, including ED. A urologist can diagnose ED and investigate what is causing it. They do this by:
- Taking a medical history: Urologists will take a detailed medical history to understand how ED affects a person and whether they have any pre-existing health conditions. They will also ask questions about sexual activity to establish the issues a person is experiencing, such as erections, ejaculation, or sexual desire.
- Performing a physical exam: A urologist will perform a physical exam to check for signs of an underlying illness, such as a person’s blood pressure and heartbeat. They will also look at the penis and testicles to check their appearance and sensitivity to touch and may test the prostate for enlargement.
- Blood and urine tests: If necessary, a urologist may order tests that measure blood sugar levels, cholesterol levels, hormone levels, and liver, kidney, or thyroid function.
- Injection test: This test involves a doctor injecting medicine that causes an erection into the base of the penis. If an erection does not result, it may suggest there is a problem with blood flow.
- Penile Doppler ultrasound: For this test, a doctor injects medicine that produces an erection into the penis. They then use ultrasound to see how well blood flows in and out of the penis through the arteries and veins.
The results of these tests will help the urologist identify the potential causes for someone’s ED and recommend the best course of treatment.
In the United States, a doctor can refer someone to a urologist after an initial consultation. Some health insurance companies may require a referral from a doctor, so speaking to them is a good place to start.
The American Board of Urology provides an online search tool that can help people find board-certified urologists in their city or state.
Some people may find it difficult to talk to a doctor about ED. However, being as open as possible will help a urologist understand how best to treat the condition.
Good communication between individuals and doctors may also have an impact on treatment. A systematic review found that males who reported the side effects of their ED treatments to a healthcare professional were less likely to stop the treatment.
Some ideas for questions to ask a urologist during an appointment include:
- What could be causing my ED?
- What tests will I need?
- Could lifestyle changes help, such as diet or exercise?
- Could the medications I take cause ED as a side effect?
- Will treating other health conditions or changing my medication fix ED?
- What treatment options are there, and do they have side effects?
- Are there any symptoms I should look out for?
- How long does it take to see results?
Doctors generally encourage people to bring their partner along to appointments and to discuss ED openly with them during their treatment.
There are a variety of treatment options for ED. A urologist will recommend treatments according to what is causing the dysfunction.
Treatments for underlying conditions
Several health conditions and lifestyle factors can cause or worsen ED, such as:
- high blood pressure
- type 2 diabetes
- multiple sclerosis
- kidney disease
- anxiety or depression
- obstructive sleep apnea and other sleep disorders
- hypogonadism, or low testosterone
If a urologist finds evidence of a health condition that could play a role in a person’s ED, they will recommend treating or managing it. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this may include:
- taking medication to lower blood pressure, cholesterol, or blood sugar levels
- taking hormones to boost testosterone or thyroid function
- changing existing drugs if ED could be a side effect
- counseling or psychotherapy to address mental health conditions
A person may also benefit from making lifestyle changes, such as:
- reducing alcohol intake
- stopping smoking or recreational drug use
- reaching or maintaining a moderate weight
- beginning regular exercise, if possible
One of the main treatments for ED are phosphodiesterase-5 (PDE5) inhibitors. These medications increase blood flow to the penis to help people get or maintain an erection. They include:
- sildenafil (Viagra and Revatio)
- tadalafil (Cialis and Adcirca)
- vardenafil (Levitra and Staxyn)
- avanafil (Stendra)
People with ED can take PDE5 inhibitors several hours before sexual activity. It is also possible to obtain suppositories or injectable medications for ED, such as TriMix, Edex, or Caverject. Urologists recommend trying these if oral PDE5 inhibitors do not work.
PDE5 inhibitors are available only via a prescription from a doctor. Most over-the-counter (OTC) supplements marketed as ED treatments are unproven and may be harmful.
In 2009, the Food and Drug Administration (FDA) found that numerous “natural” ED remedies contained unlisted drugs.
An option for people who prefer not to take medication is a pump that pulls blood into the penis via suction. This creates an erection, which a person maintains by placing an elastic ring around the base of the penis.
Penile implant surgery
For some people, penile implant surgery may be an option. Penile implants allow a person to create an erection even if other methods do not work.
Inflatable penile implants include a pump that a surgeon places inside the scrotum, which a person can then use to pump fluid into implants in the penis. Releasing a valve then allows the fluid to drain back into a reservoir. Other types of implants are semi-rigid and stay firm all the time.
Penile implants do not address aspects of sexual health such as sensation or sexual desire, but they make it possible to create erections without taking medication or planning in advance.
Scientists are also investigating other treatments for ED. In the future, a person may be able to receive:
- stem cell therapy, which could help someone grow new blood vessels
- low-intensity shockwave therapy, which may make people more responsive to ED medication
- gene therapy, which could address genetic causes for ED
However, these treatments are currently still in the development phase.
As well as urologists, other doctors may be involved in the diagnosis and management of ED. These include:
- primary care doctors
- cardiologists, if cardiovascular disease is a factor
- endocrinologists, who treat hormone conditions
- mental health professionals, such as a psychologist or counselor
ED is a common condition in middle-aged and older males that can have physical and psychological causes. A urologist can identify these causes and suggest the best treatments for each individual.
There are a range of treatment options available, including medication, pumps, or surgery. If a person has an underlying condition such as diabetes, managing this condition may help.