A history of certain previous operations, such as radical prostate surgery or rectal surgery, indicates that a patient's problem is likely physical in nature. For example, if the patient is on certain antihypertensive medications that may be changed to other drugs that would cause fewer side effects, this would be an important discovery. In addition, a few medical conditions will allow medical treatment based on the history. During the medical history we want to identify risk factors that will help us determine whether the patient's problem is physical rather than psychological. The medical history provides insight into conditions that may be contributing to the problem. The evaluation of the male with erectile dysfunction consists of four components: the medical history, the psychosexual history, the physical examination, and selected laboratory and diagnostic tests. The vast majority of patients with erectile dysfunction may be evaluated and treated successfully and never undergo any of these three studies. These studies should be done only in referral centers where large numbers of patients are evaluated daily. These last three studies are not to be done by primary care physicians or even most urologists in their office during the first and second stages of evaluation of the patient with erectile dysfunction.

For example, it's helpful in patients who have very confusing histories, and those involved in litigation where compensation may be based on the cause of the patient's erectile status problem. This technique helps demonstrate the site of a venous leakage. The cavernosography study involves the infusion of X-ray contrast solution instead of just normal saline into the corpora cavernosa during an artificial erection created by the introduction of a vasodilating drug. This can be done with or without the intracavernous injection of a vasodilating agent such as papaverine or alprostadil. Cavernosometry involves infusing saline into the corpus cavernosum - the erectile cylinders - while monitoring the intracorporal pressure. The standard diagnostic study for veno-occlusive dysfunction is pharmacologic cavernosometry and cavernosography. This study could also provide helpful information regarding venous-occlusive dysfunction.

Duplex ultrasound is useful when patients may have erectile dysfunction caused by problems with arterial blood flow. In cases where Rigiscan data is not conclusive, a sleep lab study can rule out sleep apnea and other sleep disorders, as well as confirm the Rigiscan data.