After taking your history, the doctor will probably give you a complete physical examination. This is an essential part of the medical detective work involved in diagnosing and treating erection problems. Your doctor is looking for signs of unsuspected diseases which could cause or contribute to your difficulty.

The physician should pay special attention to your pulses and arteries to check for signs of arterial disease which could make blood flow to the penis difficult or impossible. He’ll feel the arteries in your groin, behind your knee and in your feet. This may seem strange, but a sign of blockage in these arteries can be a tip-off that you have similar problems in the arteries to the penis. While your doctor may also try to feel arteries in the penis, they are very small and often escape detection. So, the state of your other arteries may be the best clue to the state of your blood-flow system.

Testing the “knee jerk” reflex in your legs and ankles is one indicator of the health of your nervous system. And the doctor may pinch your penis near the tip. He’s looking to see if your anal sphincter contracts, and checking the same response in the bulbocavernosus muscle, the one that encircles the urethra and propels semen. When these reflexes are present, it indicates that the nerves from the penis to the spinal cord and back to the penis are healthy. The absence of this reflex does not necessarily indicate a problem, but it may steer the doctor to further tests.

The doctor may test for a similar reflex by pricking (lightly!) the anal sphincter with a pin. The sphincter should contract. If it doesn’t, you may have nerve damage. The same type of pinpricks can be used to test sensations around the penis and the rectum. Brushing with a soft cotton ball also works—and feels better. The doctor may also test your ability to feel vibrations by putting a tuning fork or a special instrument on your penis. The whole point is to see if nerves in these crucial areas are functioning properly.

And, of course, a close inspection of the penis is in order. The doctor should feel your penis carefully. He’s checking for hard, lumpy scars that can be a symptom of Peyronie’s disease, which can cause impotence.


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