A strong association exists between ED and peripheral vascular disease and occult coronary syndromes. The physical examination may be an important opportunity to unmask these conditions. Assessment should include body habitus (secondary sexual characteristics), the peripheral circulation, neurological systems and genitourinary systems.
Identification of penile deformities such as Peyronie’s disease may be best achieved by stretching the penis to make the plaque more pronounced. buy ortho tri-cyclen
Assessment for occult diabetes may be performed with a fasting glucose or Hemoglobin A1c. Although recommended by the World Health Organization consensus panel, a lipid screen is not a routine component of the Canadian ED assessment, but is considered to be a valuable addition to the evaluation and a good general practice.
Hormonal profile screening is a controversial aspect of the routine evaluation of ED. In general, in men with ED and hypoactive desire, testing and treatment for low levels of testosterone is appropriate. In men with normal desire and ED, the need for global testing is controversial and currently unclear. Although it is beyond the scope of the present article, hormonal supplementation is contraindicated in men with breast or prostate cancer. Once initiated on exogenous testosterone, ongoing follow-up is recommended.
Optional tests for thyroid-stimulating hormone, luteinizing hormone and prolactin, as well as a complete blood count and urinalysis, are complementary and are not essential in the evaluation of ED in most cases.