(115) Utility of Thermography as a Screening Tool for Erectile Disorder
Authors: Kukkonen T , Hafez N , Stratton N , Binik I , Carrier S 
Published: March 2024

Abstract

Introduction
Ultrasonography remains the gold standard for the evaluation of penile vasculature in men with erectile disorder. Despite its value, ultrasound assessment can be costly for patients, and requires an intracavernosal injection prior to imaging. With estimates of psychogenic ED being up to 40% or more in clinical populations, a less invasive method of quantifying penile vascular response would be beneficial in directing patients for further assessment and treatment. One such method that has potential is thermography as it requires no genital contact, can indirectly measure blood flow through temperature change, and has been validated in self-reported clinical non-clinical populations for the measurement of sexual response.

Objective
To determine whether thermography could be used to differentiate psychogenic from organic erectile disorder by comparing thermography to penile doppler ultrasound in men being assessed for erectile disorder.

Methods
81 patients (m age = 43 years) recruited through a hospital Urology clinic completed penile vascular assessment across two different sessions: 1) thermographic measurement during a 15-minute baseline neutral and 15-minute sexually explicit film; 2) standard penile ultrasound assessment with an ICI of Prostaglandin E1. Demographic and sexual functioning questionnaires were completed, and urologist diagnosis following ultrasound assessment was used to classify patients as having psychogenic or organic ED.

Results
45 patients had PSV values consistent with organic ED, while 36 patients were classified into the psychogenic ED group. Men with organic ED were significantly older than those in the psychogenic ED group (p &lt; .05), and more likely to have concurrent health conditions (p &lt; .05). A Repeated Measures ANOVA on temperature change measured through thermal imaging demonstrated that men with psychogenic ED had significantly greater penile temperature (m = 32.45°C, SD = 1.34) during sexual arousal than those with organic ED (m = 31.73°C, SD = 1.34; p &lt;. 05), and also had a significantly (p &lt; .01) stronger correlation between their self-reported and physical sexual response during thermographic assessment (psychogenic ED mean r =.49; organic ED mean r = .27). Furthermore, a hierarchical cluster analysis of thermography measures grouped patients into three distinct categories (high, medium and low temperature change), with significantly more of the psychogenic ED group being classified into the highest temperature cluster (82%). The medium and low temperature clusters were less sensitive at differentiating organic and psychogenic ED.

Conclusions
Thermography could provide a less costly and less invasive way to screen out patients presenting with ED who have a high degree of temperature change during sexual response. While thermography has been shown to differentiate between self-reported and clinical populations, this is the first evaluation of this instrument as a tool to differentiate within ED diagnostic groups. Although men with psychogenic ED were more likely to be classified in the highest temperature change cluster, thermography was less sensitive at differentiating organic and psychogenic ED in the middle and lower temperature groupings. Further research with larger samples would be beneficial in exploring potential clinical cutoffs for penile temperature change.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Biosciences, Initiator Pharma.