The focus is on evaluation of secondary sexual characteristics, including pubic hair and penis size. The cardiovascular component should include a detailed examination of peripheral pulses, and the neurologic examination should include testing for penile sensation. The genitourinary examination should include examination of the penis for the presence of plaques as well as evaluation of testicular size and a rectal examination. The value of other testing is more controversial. Although low testosterone levels have been associated with ED, the value of various testosterone assays in the setting of ED is not clear.
Experts generally recommend at least one test.
Often, however, even if the testosterone level is low, treatment with testosterone does not result in an improvement in sexual function. Although pituitary tumors that secret prolactin may result in ED and experts recommend that a routine serum prolactin test be performed, prolactin levels are rarely elevated in ED without other symptoms. Because ED affects both the patient and his partner, the findings of the history, physical examination, and laboratory tests need to be discussed with both whenever possible before a treatment decision is made. Given the variety of treatment options, understanding the patient's and partner's preferences is important. Before providing oral medication to the patient, the clinician should explain how the medication works and provide detailed information regarding the timing of taking the medication in relationship to planned sexual activity.