Dr. Michael Safir Southern California Center For Advanced Urology

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Erectile Dysfunction - Diagnosis

Diagnosing Erectile Dysfunction

Because there are so many causes of erectile dysfunction, proper diagnosis requires testing performed at Dr. Safir’s Los Angeles urology offices. Men with diabetes, high blood pressure, and high cholesterol are much more likely to suffer from impotence. Dr. Safir uses an advanced procedure called color Doppler ultrasound to measure blood flow to the penis. If the ultrasound shows that blood flow is impaired, it shows a vascular problem is causing the erectile dysfunction. Color Doppler can differentiate between erectile dysfunction caused by arteries and erectile dysfunction caused by veins. This is important, as treatments vary depending on the cause. Some of these causes include:

  • Hormones: Low testosterone can be one cause of erectile dysfunction, but this usually results in an overall loss of libido as well. So if “the spirit is willing but the flesh is weak,” low testosterone is probably not the culprit.
  • Psychological Factors: Sometimes, psychological factors such as performance anxiety and depression may cause ED. Even if your erectile dysfunction is not caused by psychological factors, you may experience psychological symptoms as a result of ED: depression, anxiety, stress, and relationship difficulties. This is why accurate diagnosis and proper treatment of erectile dysfunction are so important.
  • Nervous System: If the nerves leading to the penis are damaged, the electrical messages to permit increased blood flow to the penis are interrupted. This causes erectile dysfunction. Nerve damage often occurs in diabetes, but may also be seen in spinal cord and pelvic injuries, multiple sclerosis, Parkinson’s disease, and after certain surgeries for prostate or bladder problems.
  • Medications: Many medications can cause male impotence. Medications used to treat high blood pressure are especially problematic, as are antidepressants and antianxiety drugs. Certain antihistamines, pain relievers, and even antacids can also cause erectile dysfunction.
  • Vascular Problems: The most common causes of erectile dysfunction (approximately 80% of cases) are vascular problems. Since proper flow of blood to and from the penis is required to create and maintain an erection, blood vessels need to be healthy.

Men with diabetes, high blood pressure, and high cholesterol are much more likely to suffer from impotence. This is because these conditions are often characterized by blocked arteries (atherosclerosis). Sometimes, erectile dysfunction can be the symptom that indicates these underlying diseases. Cigarette smoking is also linked with male impotence. Nicotine causes blood vessels to contract, reducing blood flow to the penis.


Less common than arterial blockage is venous leak. This occurs when blood leaks out of penile veins, which prevents an erection from being sustained. Venous leak may be caused by injury or certain types of diseases.

The Difference That Dr. Safir Brings...

Dr. Michael Safir is not only a board-certified urologist; he is also a nationally-renowned urologic surgeon. He specializes in the rapidly developing field of reconstructive urology. Dr. Safir is one of only a handful of urologists worldwide to have completed separate fellowship training in reconstructive female urology surgery (at UCLA) and male genitourinary surgery (at UCSF). The American Board of Medical Specialties has just recently recognized female pelvic reconstructive surgery as a distinct subspecialty.

Dr. Safir lectures at medical conventions and seminars, and travels throughout the country training other urologists and gynecologists in the latest, advanced techniques for surgical treatment of urinary incontinence and pelvic prolapse.

Dr. Safir has also trained with some of the nation's leading urologists, including Dr. Paul E. Perito www.peritourology.com.

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Michael Safir, M.D. speaks candidly about various urological conditions and the advanced surgical procedures used in his practice.

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