In the physical examination we check whether there is a normal pattern of male hair growth, we listen with the aid of a stethoscope to see if there are any indications of vascular constriction, and if necessary we test reflexes, and feel the penis and the scrotum.

Physical examination of a man with ed does not generally provide any information that was not already perfectly obvious. Nevertheless there are plenty of men who believe that their complaint is the first symptom of a serious disease, and unfortunately this is occasionally the case. In young men the danger is multiple sclerosis and in older men serious cardiovascular disorders. Other diseases which are known to cause erection problems are long-term high blood pressure, leukaemia, serious kidney diseases, hyper – or hypothyroidism, diabetes, underde­veloped or bilaterally damaged testicles, hyper – or hypoactivity of the hypophysis, overactive adrenal glands, amytrophic sclerosis (also an ailment of the spine), spinal cord lesion, serious epilepsy, hernia of the back, Parkinson’s disease and, last but not least, inflammation of the prostate.

If cancer requires the removal of the prostate, bladder, or rectum, this also leads in most cases to ed. Because the surgeon has to keep a margin of healthy tissue around the tumour in order to ensure a last­ing recovery by the patient, it is inevitable that some nerves involved in erection will be damaged. It is hence extremely important that the patient should be informed of this before the operation. Radiotherapy can also cause ed.