Erectile Dysfunction Assessment: What the First Visit Covers

Written by Dr. Ashutosh A Shah, M.B.B.S., M.S., M.Ch., D.N.B., Plastic and Reconstructive Surgeon.

Medically reviewed by Dr. Ashutosh A Shah · Written for adults

The first erectile dysfunction assessment is mostly a conversation. The doctor takes your sexual, medical and lifestyle history, may use a short questionnaire, does a brief examination with your consent, and orders simple erectile dysfunction tests such as blood sugar, cholesterol and sometimes testosterone. Most men do not need a scan at the first visit.

Many men delay seeing a doctor because they imagine an embarrassing examination or a long list of tests. In reality, an erectile dysfunction diagnosis rests mainly on talking, and the tests are the same as a standard men's health check up. This step-by-step guide explains what happens at the first visit, which tests are common, and how to prepare. If privacy worries you, read how a confidential sexual health consultation works.

What happens at the first visit, step by step?

The visit follows a simple order. A medical review of erectile dysfunction in the Medical Journal of Australia describes the same core steps: history, questionnaire, focused examination and basic blood tests.

1. Your story: when the problem started, whether it came on suddenly or slowly, and whether it happens every time or only sometimes.
2. Sexual history: getting versus keeping an erection, morning erections, desire, ejaculation and any change with a partner.
3. Medical history: diabetes, blood pressure, heart problems, surgery, injury and all your medicines.
4. Lifestyle and mood: smoking, alcohol, sleep, stress, anxiety and relationship worries.
5. Short questionnaire: a five-question score, such as the IIEF-5 or SHIM, to measure severity.
6. Brief examination, only with your consent.
7. Tests and plan: which erectile dysfunction tests are needed, and the first treatment options.

In our practice, many men find the first visit is shorter and easier than they expected. Most of the useful information comes from the conversation, not the tests.

What questions will the doctor ask?

The questions are direct but routine. Clear answers help the doctor tell physical causes from stress or anxiety.

• Do you still get erections in the morning or at night?
• Is the problem getting the erection, keeping it, or both?
• Did it start suddenly or slowly over months?
• Does it happen with every partner and situation?
• Have you noticed lower desire, tiredness or loss of muscle?
• Do you have pain, a bend or a lump in the penis?
• Which medicines, supplements or substances do you take?

The MJA review notes that a sudden start in a younger man with normal morning erections points more towards stress or anxiety, while a slow start with risk factors points towards a blood vessel cause.

What does the physical examination involve?

It is short and focused, and you can ask for a chaperone. The doctor usually checks:

• Blood pressure, weight and waist size.
• The penis: for a bend, plaque or tight foreskin.
• The testicles: size and feel, which can hint at low hormones.
• Signs of low testosterone: body hair, breast tissue and muscle.
• Prostate check: sometimes advised for men over 50 or with urinary symptoms.

Which erectile dysfunction tests are usually done?

Mostly simple blood tests. They look for the health conditions that often sit behind erection problems, as explained in our guide to erectile dysfunction causes.

Test	What it checks	Who usually needs it
Fasting sugar or HbA1c	Diabetes or pre-diabetes	Almost every man
Lipid profile	Cholesterol, which affects blood vessels	Almost every man
Morning testosterone	Low male hormone	Men with low desire, tiredness, diabetes or a poor response to tablets
Kidney and liver tests	Organ health and medicine safety	Often, depending on history
Thyroid or prolactin	Other hormone problems	Selected men
PSA	Prostate health	Older men or those with urinary symptoms, after discussion

Testosterone is best tested in the morning, when levels are highest. If it is low, our page on low testosterone explains the next steps.

When are specialised tests needed?

Not often. The MJA review states most men do not need further investigation unless there is a specific reason. Extra tests are considered when:

• Treatment with tablets has not worked.
• Erection problems have been present since youth.
• There has been injury to the pelvis or genitals.
• There is a bend, plaque or other change in the penis.
• Surgery, such as a penile implant, is being considered.

The main test then is a penile colour Doppler scan, which checks blood flow into and out of the penis. Some men with several heart risk factors are also advised a heart check, because erection problems can be an early sign of blood vessel disease.

How can you prepare for an erectile dysfunction diagnosis?

A little preparation makes the visit faster and more useful.

• Bring a list of all medicines and supplements.
• Bring recent blood reports, if you have them.
• Note when the problem started and how often it happens.
• Think about morning erections and desire.
• Write your questions down if saying them aloud feels hard.
• Bring your partner if you wish, or come alone.

What happens after the tests?

The doctor explains the likely cause and the options. Many men can start a plan at the first or second visit.

1. Treat any health problem found, such as diabetes, cholesterol or low testosterone.
2. Change habits that affect erections, like smoking, alcohol and weight.
3. Start erection treatment if needed. See erectile dysfunction treatment.
4. Arrange counselling if stress or anxiety plays a part.
5. Review progress and adjust the plan.

Our erectile dysfunction page explains the condition in more detail.

 

Next step

If erection problems have become regular, the first assessment is a straightforward, private conversation followed by simple erectile dysfunction tests. Book a consultation and bring your medicine list and any recent reports.

This page is for education and is not a substitute for medical advice. The tests you need depend on your own history and examination. Do not start erection medicines without a doctor's review, especially if you take heart medicines.