What is he thinking?
For once, I’m going to put on my physician’s hat and give you the view from the other side.
Well, my first step was to review the medical records to see if there were any immediate clues. If there are existing diseases or one of the medications currently on prescription has an ED side effect, we have solved the case before we start. I should let you in on a small medical secret. About a quarter of all the cases that we see are drug-related. Usually, we simply change the medication and the ED goes away. Alternatively, we have to counsel lifestyle changes because the excessive alcohol consumption or recreational drug of choice is not doing the patient any favors.
So my patient has walked through the door and, in the same breath as blurting out that he’s suffering erectile dysfunction (ED), he’s also into the knee-jerk questions about where to buy Viagra, should he risk buying Viagra online, and so on. I know Pfizer Inc. did a wonderful thing when they invented Viagra, but that medication so dominates the public consciousness that many men seem have never even heard about Cialis and Levitra, let alone all the other treatments that are available and may be necessary. Still even though my patients are predictable, they are at least coming through the door to get treatment. Ten years ago that did not happen. The world is a better place thanks to Pfizer Inc. The next most obvious possibility is Diabetes. I may also do a blood sugar test just to be thorough. Blood pressure tests out in the normal range, so that’s another good sign.
The questions are designed to establish whether we’re dealing with problems of desire (which could be psychological or physical), whether it’s purely ED or there are also problems with achieving orgasm, and to check up on those lifestyle choices which could be the real problem.
The physical examination tries to cover as many possibilities as possible in as short a time as possible. Most men find an examination deeply embarrassing so keeping it short is a “good thing”. I’m looking for anything that might suggest a systemic problem. So, I’m obviously going to start with the penis. Some of my questions have probed whether the penis has changed shape in any way or perhaps the erection is painful. A physical examination could find evidence of lumps or the answers to the questions may reveal that the penis now bends or curves when erect, all of which could suggest Peyronie’s disease. Similarly, if the penis is not sensitive when I touch it, this may indicate possible problems in the peripheral nervous system.
Following the same idea and taking a quick overview of the body also allows me to look for any changes to the usual distribution of body hair or any enlargement to the pectorals (a polite way of suggesting that my patient may be developing small breasts). If the testicles feel slightly smaller than I would expect, this can suggest a low testosterone level. Any such abnormality can indicate problems with the hormone balance or the endocrine system. I’m also testing the pulses in both the wrists and ankles. If there are any circulatory problems, I’m likely to find a decrease pulse at the extremities.
So these are all the quick and easy explanations. In most cases, there is little to suggest the need to go on to further tests and I can then get into a discussion of the medication options. This is when the patient finally begins to look more comfortable again. We have finally come back to his original questions, except that I’m also telling him about Cialis and Levitra. Viagra may have the name, but Cialis in particular does have some interesting characteristics.