In addition to a routine physical examination, further examination depends on the patient’s age, general health and treatment goals.
The genitalia and secondary sexual characteristics need to be looked at closely, with particular attention given to the size and consistency of the testicles and penis. Tissue atrophy (shrinkage) with a decrease of the “bulk” and elasticity of the penis occurs in men suffering from ED caused by a physical problem. A plaque, firm lumps or scar can be palpated and are evidence of Peyronie’s disease
. These are typically found in patients with diabetes
, hypercholesterolemia and small vessel disease, or following trauma or abdominal or pelvic surgery (prostate)
. If present, this indicates that the integrity of the cavernosal smooth muscle erectile tissue including the outer layer that surrounds the muscle and provides structural firmness (tunica albuginea) are being replaced by scar tissue. The combination of the muscle shrinking and the loss of elasticity (ability to stretch) of the tunica albuginea compromise the mechanism by which blood is retained and trapped in the penis during an erection. A commonly described symptom of this condition would be an ability to obtain but not maintain an erection during sexual activity.
What provides a firm erection in young men is the presence of healthy bulky muscle tissue combined with a stretchy and elastic tunica. Ironically, as the flesh becomes stiff, the firmness, quality, size and duration of the erection deteriorate. This goes further in explaining the cause of ED rather than the simplistic model of a blocked artery.
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