Physical examination
A physical examination may be performed to look for clues to the etiology of erectile dysfunction. The examination will center on proper evaluation of the genital system. Any abnormal curvature of the penis or any other penile abnormalities will be checked for. The tests will be evaluated for size and location. Hormonal issues such as hypogonadism leading to low testosterone levels may manifest as lack of facial hair, a small size of the testicles and abnormal increase in breast size (gynecomastia). Atherosclerosis may be checked by feeling the hardness of the arteries in the groin region.

 Blood tests
The blood tests to be done in a patient of erectile dysfunction will vary from a case to case basis. The common investigations that your doctor may ask for include the following:

• A complete blood count is done routinely in such patients.
• Blood glucose levels are checked for the presence of diabetes mellitus. Complications of diabetes such as nerve damage, kidney injury and retinal disease are also checked for in long-standing patients with diabetes.
•   Increasingly, the glycosylated hemoglobin levels, or HbA1C levels, are used to diagnose and monitor long-term glucose control.

• A lipid profile may be asked for to look at LDL cholesterol (bad cholesterol) levels.
• Urine analysis studies may be done to check for high sugar and protein content. These may again be indicative of diabetes mellitus.
• Serum creatinine levels may help to assess the adequacy of the kidney function.
• Liver function tests may be deranged in some cases.
• Total testosterone levels may be checked as well. Blood samples should be collected early in the morning and positive tests should be repeated for confirmation.
• Other hormones that may be tested for include the thyroid hormones, cortisol, prolactin and luteinizing hormone. These tests are useful in evaluating other physical causes of erectile dysfunction.
• Prostate-specific antigen levels may be checked to rule out the presence of prostate cancer.
• Tests to rule out other cancers (colon cancer, leukemia) and other blood disorders may be carried out in select cases.

Imaging

Infrequently asked for in patients with erectile dysfunction, the imaging tests that may be used include an ultrasonography with Doppler imaging of the genital regions. These may help to assess the blood flow in the arteries supplying the penis and testis. They may also serve as good preoperative guides in patients posted for surgical intervention. Other radiological tests that may be asked for include an X-ray and angiograms.

Psychological Examination

A thorough psychological evaluation may be carried to determine the stressors, relationships and other psychosocial issues that may play a role in finding the cause and treatment of erectile dysfunction. The affected person’s partner should also attend the same.