While additional workup is usually necessary, the medical and sexual history is essential and frequently the most revealing aspect of the ED assessment process [5]. Although not always definitive, a detailed history may provide suggestive evidence for or against the role of specific organic or psychogenic factors and should be obtained in all cases of ED. A detailed description should be made of the rigidity and duration of both erotic and morning erections and of problems with arousal, ejaculation, and orgasm [6]. Documenting a medical history has several goals [6–8]. First, it is important to evaluate the potential role of underlying comorbidities. ED may be symptomatic of an underlying comorbidity, such as atherosclerosis or diabetes. Second, a possible association with cardiovascular conditions to differentiate among potential organic and psychogenic causes in the etiology of a patient’s sexual problem must be investigated. Third, the history helps to assess the use of concomitant medications. Some of these medications can either cause or contribute to ED, and a change in medication may result in an improvement in sexual function. Additionally, the use of certain medications (e.g. nitrates) may be important contraindications for specific treatments. Interviewing the patient’s partner during the ED assessment is also usually advisable.

Standardized questionnaires are frequently used to confirm that the disorder is truly ED and to measure its severity. They are also valuable research aids that help assess the response to different treatments of ED. Several questionnaires are available. Two of the most practical and easily administered are the International Index of Erectile Function (IIEF) and the Sexual Health Inventory for Men (SHIM) [9, 10]. The IIEF, a 15-item, self-evaluation questionnaire is a validated instrument for assessing erectile function, orgasmic function, desire, and satisfaction after sexual relations [9]. An abridged version of the IIEF is a five-item questionnaire the SHIM or IIEF-5 (Table 1.2). Responses to the five questions range from 1 (worst) to 5 (best). Questions 2–4 may be graded 0 if there is no sexual activity, or no sexual intercourse attempt) and the final score ranges from 1 to 25 points; a descending score indicates worsening of erectile function, with values ≤21 being diagnostic of ED [10]. Importantly, validated questionnaires correlate with the extend of coronary artery disease and improve the predictive value of ED for total cardiovascular events compared to a single-question ED diagnosis [11]. It cannot be overemphasized that the SHIM can be effectively used not only by andrologists and urologists but by a wide array of medical specialists, such as cardiologists, diabetologists, primary care physicians, etc.
< div class='tao-gold-member'>