A focused physical examination must be performed on every patient, with particular emphasis on the genitourinary, endocrine, vascular and neurological systems1. The physical examination may reveal unsuspected findings, such as Peyronie’s disease, prostatic enlargement or cancer, as well as the signs and symptoms indicative of hypogonadism (small testes, alterations in secondary sexual characteristics, diminished sexual desire, and changes in mood)2. A rectal examination should be performed in every patient older than 50 years. Blood pressure and heart rate should be measured if they have not been assessed in the previous 3-6 months. Particular attention must be given to patients with cardiovascular disease.
1. Davis-Joseph B, Tiefer L, Melman A. Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction. Urology 1995;45:498-502. http://www.ncbi.nlm.nih.gov/entrez/query
2. Hatzichristou D, Hatzimouratidis K, Bekas M, Apostolidis A, Tzortzis V, Yannakoyorgos K. Diagnostic steps in the evaluation of patients with erectile dysfunction. J Urol 2002;168:615-620. http://www.ncbi.nlm.nih.gov/entrez/query