Erectile dysfunction (ED) has been defined as the persistent inability to achieve and/or to maintain an erection for a satisfactory sexual intercourse. This event can occur occasionally without inducing psychological or managerial problems, but frequent ED can lead to emotional and relational disorders which can often reduce self-esteem, reinforcing dysfunctional processes.

ED represents a very important public health problem and can strongly compromise both the patient and the couple’s quality of life because of a combined presence of organic and psychological aspects and frequent correlation with clinical comorbidities.

Diagnosis of erectile dysfunction does not require complicated tests. After taking a history of sexual function and general medical factors, the doctor will do a physical examination of the penis, testes and prostate. Blood tests are done to check glucose (sugar levels), cholesterol and testosterone levels.

Physical examination in erectile dysfunction should involve careful assessment of the external genitalia to detect the presence of cutaneous penile lesions, a Peyronie’s plaque or testicular abnormalities (Figures 39, 40, 41, 42, 43,

44). Rectal examination should be performed to exclude benign prostatic hyperplasia or induration/nodularity suggestive of prostatic cancer. A focused neurological evaluation, including assessment of anal sphincter tone, should be performed and peripheral pulses palpated to detect signs of vascular disease. The distribution of body hair may provide a clue to androgen status. Blood pressure should be recorded with the patient both standing and lying down, and the presence or absence of obesity and/or gynecomastia noted.

The abdomen should be palpated to exclude aortic aneurysm.