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Erectile Dysfunction (Impotence)

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DIAGNOSIS OF CAUSE OF IMPOTENCE

First step in proper treatment of  Erectile Dysfunctions (impotence) is accurate diagnosis of cause. So we first try to find out cause. We take detailed history, thorough sex counseling, physical examination, examination of nerves and Penile arterial examination. After that depending on likelihood of particular, cause relevant tests are done All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests. done. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.



DETAILED HISTORY:
We take detail history about the onset of eredtile dysfunction i.e. whether it started Sudden or gradual, Primary or Secondary,  Erections at other occasions, Response to previous therapy, Libido, Stress (physical or mental), H/O precipitation by some drugs, presence of Hypertension, Ischemic Heart Disease , claudication, trauma, DM, Sec. Sexual Characters, Hypothyroidisms, Hyperthyroidisms & Galactorrhoeas, Symptoms of sensory loss, epilepsy, Liver/Renal failure. 


EXAMINATION OF GENITALS:
We examine whether Sexual Development is adequate or subnormal. For this testis size is measured by orchidometer (if patient is outstation then by ultrasound of testis) , Penis Length & girth is measured by phallometer. Galactorrhoea & features of other hormone disorder are checked up. Blood supply of penis is assessed by, palpating dorsal penile artery of penis. Nerves of penis examined by sensation testing, Deep Tendon reflexes & Bulbocavernosal reflexes. Then other systems are examined. 

INVESTIGATIONS i.e. DIAGNOSTIC TESTS:

At our centre we have all the facility for complete investigation of various causes of Erection difficulties & other sex problems. So we perform following tests, step by step depending on their need based on history & examination. 
The various diagnostic tests needed/performed are as follows: - 

Step- I: Hormone Testing: There are two types of hormones in body some stimulates penile hardness whereas there are other hormones which inhibit penile stiffness. 
Male & Female sex hormones & other associated Hormones are tested by latest-immunoassay techniques. These hormones includes total Testosterones, free testosterones, Prolactins, LH, FSH, T3, T4, TSH others as Cortical, E2, Free testosterones SHBG etc.. Among above tests relevant hormones are tested in that particular patient. Results are available in 36 hours. In the hormone testing either stimulatory sex hormones may be low leading to less erection or those hormones which are inhibitory may be high leading to inhibition of penile erection. These hormones are tested by taking blood sample from forearm. When we find out any of above hormone disorder simply correction of these hormone disorders corrects the erectile dysfunctions in two months time. 
Blood glucose & other systemic test may be required depending on the need. 


Step I1: Penile Blood Supply Testing: 
This test is done to decide whether impotence is due to decreased blood supply to penis or disorders of nerves or due to some other causes. This test is also called PIPE (Pharmacological induced penile erection) test.
In this test we examine the dorsal penis artery & veins after giving the various Vasodilators either orally or as injectable, also we asses whether penis is getting full hard or not after vasodilator use, how long hardness is persisting in response to theses vasodilators. If penis is not becoming fully hard or not staying hard for at least fifteen minutes even after adequate dose of vasodilators than cause of impotence is inadequate blood supply to penis or due to leakage of blood out of penis due to venous leak. If penis is getting full hard and staying longer than fifteen minutes then cause is nerves of penis are not functioning or some other cause. There are two types of blood supply disorders are found on blood supply testing.

The first pattern is suggestive of penile arterial blockade in which blood does not flows in penis from blood circulation due to block in arterial supply of penis. This obstruction in vascular supply is diagnosed by above mentioned blood supply test in which after giving blood flow medicine we find that there is increase in blood flow in arteries of penis is less than normal with resultant absence of achievement of full hardness of penis for sufficient time. This test is very simple to perform if the concerned doctor is well trained & experienced. This is an O. P. D. procedure & takes approximately 30 minutes to perform the test. We do these tests daily at our centre as we have all the required instruments to do these tests. Once we diagnose that there is decreased blood supply to penis then we find out the cause of this inadequate blood flow. 

Once the cause of decreased blood supply is diagnosed then treatment becomes very easy with virtually full chances of permanent cure.

Second pattern found on blood supply testing is Leakage of blood out of penis back into circulation after initial full erection (also known as Veno-occlusive dysfunction): In this defect, blood flows from circulation to penis normally but due to continuous leak of blood out of penis due to defect in penile valves whose job is to stop the leakage of blood out of penis, enough penis hardness is either not achieved or even if penis becomes fully hard it become loose there after due to leakage of blood out of it. When we do blood supply testing, in this disorder there is good blood flow in arteries of penis through out study, but there is continuous leakage of blood is seen through valves of penile veins. 

Step-3: N.P.T. MONITORING: Penile Erection assessment at night (called as nocturnal penile tumescence) is done by Rigiscan device (it measures penile rigidity & diameter) to differentiate between impotence of psychogenic origin or due to some internal cause. If N.P.T. monitoring shows Normal results it means impotence is Psychogenic, if results are impaired means impotence is due to some internal cause. 

Step 4: DUPLEX SCANNING: (Doppler & ultrasound scanning before & after vasodilator use) In this Testing with use of vasodilator drugs/Duplex vascular scanning is done to decide which type of problem patient is suffering, accordingly treatment is prescribed. It assesses arterial diameter & blood flow status. It helps in differentiating & pinpointing the cause of impotence i.e. whether it is arterial or venous cause & what is the specific cause of that problem so that it can be treated properly.

Step 5: Sex Counseling: After detail discussion with our male & female sex therapist, we try to finds out the root cause of sex problem then we treat accordingly. For counseling we take detail history of sexual development, his thoughts, his misconception about sex, his old experience in sex, his unconscious fears about sex. This counseling session unravels all the hidden psychological causes of sexual inadequacy.

Step 6: Other tests (If required)

1) Penile Nerve Testing: By conduction and sensory testing (NCV, EMG & VPT). 
2) Psychoanalysis: To find different factor leading to psychogenic impotence.
3) Functional Studies: To see the penile response in provocation to various drugs.
4) 5) Arteriography:  It is a Specialized X-Ray of penis before arterial opening i.e. opening of the blockade  surgery. In this test a drug (dye) is infused which detects whether block is situated , whether it is localized or diffused. Once we localized the obstruction & its cause, then we decide whether it can be cured through medicine or surgery. 

5) Cavernosometry & cavernosography (before venous leak surgery).

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We get patients from all major cities in India & Abroad . In the following cities all the facilities for investigation & treatments including medicines are available as Delhi (North, South, East, Central, West, New Delhi). To Different Communities like Hindustani, Hindustan, Hindu, Christian, Muslim, Sikh, Parsee. The other cities are NCR, National Capital Reagion in India, Indian, Hindustan, Ghaziabad, Faridabad, Noida, Gurgaon Gurugram, Meerut, Bombay, Chandigarh, Calcutta,  Simla, Jammu, Srinagar, Aligarh, Lucknow, Kanpur, Allahabad, Varanasi, Dehradun, Madras, Kolkatta, Nainital, Agra,  Jaipur, Bikaner, Jodhpur, Porbandar, Dwarka, Ahmedabad, Gandhi Nagar, Vadodara, Surat, Mumbai, Pune, Thane, Panaji, Nasik, Nagpur, Indore, Ujjain, Bhopal, Gwalior, Jabalpur,  Raipur, Hyderabad, Goa, Visakhapatnam, Bangalore, Banglore, Bangalooru, Mysore, Mangalore, Manipal, Chennai, Pondicherry, Madurai, Kanchipuram, Coimbatore, Kanyakumari, Ernakulam, Trivandrum, Darjeeling, Gangtok, Bhubaneswar, Puri, Guwahati, Shillong, Imphal, Kohima, Agartala, Patna, Ranchi.

We provide treatment for : Erectile disorder Treatment Specialist Delhi Doctor India New Noida best qualified Indian East West North South Central Gurgaon Gurugram Faridabad Ghaziabad hormone therapy  is one of the very remarkable advancement in the last 5 years.