Peyronie's disease is addressed further in this part. Examination of the genitals may also reveal abnormalities that could interfere with effective treatment, such as Peyronie's disease, a curvature of the penis caused by plaque formation. If the penis does not respond as expected when touched in a certain way, impotence may be attributed to a problem in the nervous system. The doctor will also carefully check the nerves in the genital, area. For example, small, soft, shriveled testicles or abnormal secondary sex characteristics, such as enlarged breasts or an abnormal hair pattern, suggest a hormonal problem. A thorough physical examination, with special attention to your genitals, can provide important information and, occasionally, reveal an obvious cause of ED. Before giving testosterone to any man over 45 years old, a detailed prostate examination (including prostate-specific antigen test and, if necessary, prostate ultrasound and biopsy) is strongly recommended.

Because of the high incidence of prostate cancer in older men, the indiscriminate prescription of testosterone may speed the growth of many microscopic prostate cancers and pose a real threat to a patient's well-being. However, millions of dollars are spent every year because of the false belief that testosterone boosts sexual drive and, therefore, improves potency. For example, the presence of high blood pressure, an irregular heartbeat, or an abdominal aneurysm - a ballooning of the aorta, which is the main blood vessel leading to the heart - might indicate a circulatory problem that can affect your ability to achieve and maintain an erection. The physical examination may also offer other, less obvious clues to the cause of ED.