Arterial vascular diseases account for nearly half of all cases of ED in men older than 50 years of age. Arterial vascular disease includes atherosclerosis (fatty deposits on the walls of arteries, also called hardening of the arteries), which may affect the heart (history of heart attacks, angina, coronary artery disease, myocardial infarct) or blood vessels in the legs, peripheral vascular disease (problems with blood circulation to the legs), as well as other areas of the body including blood vessels supplying blood to the penis and high blood pressure. Prolonged tobacco use (smoking) is considered an important risk factor for ED because it is associated with poor circulation and reduced blood flow in the penis. This is related to microvascular damage (stiffening of the artery as well as smaller caliber vessel size secondary to endovascular atherosclerotic plaques).
A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.