Erectile Dysfunction: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height [obesity (overweight): current body weight versus age-related ideal weight: increase in body weight with increase in body fat percentage; decreasing muscle strength; visceral adiposity* → free testosterone↓; peripheral edema/water retention; alopecia/hair loss, hair distribution?]; furthermore:
    • Inspection (observation).
      • Skin and mucous membranes [due topossible male andropause/menopause: dry and brittle skin; hot flashes and sweats; balding forehead hair, decreased beard growth].
    • Auscultation (listening) of the heart and measurement of blood pressure and pulse [due todifferential diagnosis: hypertension / hypertension].
    • Inspection and palpation (palpation) of the mammae (mammary glands) [gynecomastia/enlargement of the mammary gland?]
    • Inspection and palpation of the abdomen (stomach), inguinal region (groin region) (pressure pain?, knock pain?, release pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
    • Inspection and palpation of the genitals (penis and scrotum; assessment of pubes hair (pubic hair), penis (penis length: in flaccid state between 7-10 cm/erect penis state: median length of erect penis 14.15 ± 2.66 cm (range between 4 and 26 cm); presence of: Indurations (tissue indurations), anomalies, phimosis/foreskin stenosis, balanitis/ichelitis?) and testicular location and size (by orchimeter; size, suspicious palpation findings (palpation findings)?) [due toDifferential diagnosis andropause: decrease in testicular volume].
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency [painful palpation of the prostate?]
  • Neurologic examination – including assessment:
    • Tone of the anal sphincter (anal sphincter).
    • Checking the bulbocavernosus reflex (BCR; synonyms: bulbospongiosus reflex, ejaculatory reflex) Trigger: compression of the glans; effect: muscle contraction of the bulbospongiosus muscle and the ischiocavernosus muscle; nerve pathways involved: Nervus pudendus (pubic nerve) S3-S4; during ejaculation, irritation of the glans leads to rhythmic contraction of the two muscles mentioned above, resulting in the expulsion of sperm (semen).
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.

* Indications of significant visceral obesity (synonyms: android obesity: male fat distribution pattern emphasizing the abdomen; also called abdominal or central obesity or “apple type”) result from:

  • BMI (body mass index; body mass index (BMI)) > 30.
  • Waist-hip-ratio (WHR; waist-to-hip ratio (THV)) > 0.9