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During the physical examination, signs of hypogonadism, such as gynecomastia or the loss of axillary and pubic hair, should be noted.4 The genital examination should include an evaluation of the size and consistency of the testes. The penis should be examined for any fibrosis and plaques indicative of Peyronie's disease.8 Finally, the bulbocavernosus and cremasteric reflexes should be assessed to eliminate a neurologic cause of the erectile dysfunction. The bulbocavernosus reflex is elicited by squeezing the glans penis while observing for contraction of the external anal sphincter. This may be visualized or felt during a digital rectal examination. more link Let your partner know that he's not alone. Remind him that ED is a fairly common and very treatable medical condition. ED is not a reflection on his masculinity or a lack of attraction or desire for you. You should also support your partner in any efforts to change his lifestyle (such as encouraging a proper diet, quitting smoking or use of any recreational drugs, etc.) to deal with ED. Hypertension Diabetes Peripheral vascular disease -- This disease particularly affects blood vessels that supply blood to the lower extremities The first step to overcoming these feelings is to acknowledge the problem and communicate honestly and openly with each other. Topiglan: Still under investigation, a cream applied to the penis called topiglan uses the same drug (alprostadil) that is used in injection therapy and suppository therapy. If topiglan proves to be safe and effective, it is still not entirely clear which patients would benefit from its application and whether patients on injection and suppository therapy would no longer have to use these techniques.