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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.

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.

What causes ED?

ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED.

Because an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases-such as diabetes, high blood pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease-account for the majority of ED cases. Patients should be thoroughly evaluated for these conditions before they begin any form of treatment for ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED. Smoking, drinking alcohol excessively, being overweight, and not exercising are possible causes of ED.

Surgery-especially radical prostate and bladder surgery for cancer-can also injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa.

In addition, ED can be a side effect of many common medicines such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug.

Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure can also cause ED. Even when ED has a physical cause, psychological factors may make the condition worse.

Hormonal abnormalities, such as low levels of testosterone, are a less frequent cause of ED.