Initial Workup for Erectile Dysfunction

History Taking Components

The initial workup for erectile dysfunction should include a comprehensive sexual, medical, and psychosocial history, focused physical examination, and laboratory testing including morning serum total testosterone levels, as recommended by The Journal of Urology 1, 2
A sexual history should be taken to identify onset of symptoms, symptom severity, degree of bother, difficulty with attaining and/or maintaining erections, situational factors, presence of nocturnal/morning erections, and prior treatments, according to The Journal of Urology 1
A medical history should be taken to assess age, comorbid conditions, prior surgeries, medications, family history of vascular disease, and substance use, as recommended by The Journal of Urology and Diabetes/Metabolism Research and Reviews 1, 3
Psychosocial factors should be evaluated, including relationship status, quality of relationship with partner, psychological conditions, and major life events, according to BMJ 4, 5
A medication review should be conducted to identify medications associated with ED, particularly antihypertensives, tranquilizers, antidepressants, and recreational drugs, as recommended by Diabetes/Metabolism Research and Reviews and BMJ 3, 5

Vital signs, including blood pressure and pulse, should be taken during the physical examination, as recommended by The Journal of Urology and BMJ 1, 4
A genital examination should be conducted to assess for penile skin lesions, urethral meatus placement, occult deformities or plaque lesions, and testicular size, according to The Journal of Urology and BMJ 1, 4
Secondary sexual characteristics should be evaluated for signs of hypogonadism, as recommended by The Journal of Urology 6
A cardiovascular assessment should be conducted, including checking lower extremity pulses, as recommended by The Journal of Urology 2, 6

Essential laboratory tests for ED include morning serum total testosterone level, fasting glucose or hemoglobin A1c, and lipid profile, as recommended by The Journal of Urology and Diabetes/Metabolism Research and Reviews 1, 3
Additional testing, such as thyroid-stimulating hormone, prostate-specific antigen, free testosterone, or androgen index, may be indicated based on history and examination, according to BMJ and The Journal of Urology 2, 4

ED is a risk marker for underlying cardiovascular disease and should prompt evaluation of cardiovascular risk factors, as recommended by The Journal of Urology 1
Psychological evaluation and referral to a mental health professional may be necessary for patients with ED, according to The Journal of Urology and BMJ 1, 7
Specialized testing, such as vascular assessment, neurological testing, or nocturnal penile tumescence evaluation, may be indicated for select patients who don't respond to initial therapy, as recommended by The Journal of Urology 2

Sudden onset of ED often suggests psychogenic causes, while gradual onset typically indicates organic etiology, according to BMJ 4
The presence of morning or nocturnal erections suggests, but does not confirm, psychogenic ED, as recommended by The Journal of Urology 1
Validated questionnaires, such as the International Index of Erectile Function or Sexual Health Inventory for Men, can help initiate discussion and objectively assess severity, according to The Journal of Urology and Diabetes/Metabolism Research and Reviews 1, 3