The Diagnostic Process
Erectile Dysfunction Center

A Comprehensive Approach from Diagnosis to Treatment


Obsidian offers an array of diagnostic testing for clients with erectile dysfunction. We’ll work with you to get your complete medical history and give you a thorough physical exam to determine the best approach. Extensive laboratory tests — bloodwork to detect diabetes, high cholesterol, liver disease and thyroid abnormalities, among others — will help us determine what might be wrong and how to fix it. We’ll also conduct a prostate-specific antigen (PSA) test, as well as obtaining more advanced PSA derivatives, to rule out prostate cancer, one potential cause of ED.

We’ll likewise do sophisticated blood tests to evaluate your testosterone balance, measuring both bioavailable and free testosterone, and determine your estrogen and pituitary-hormone levels to pinpoint any hormonal abnormalities. When necessary, we’ll do advanced vascular and neurologic testing — penile Doppler studies and nocturnal-tumescence readings — to be sure we’ve zeroed in on the cause.


Obsidian comprehensively evaluates men’s erectile dysfunction — it’s the best way to pin down the specific cause of the problem and devise the optimal treatment.

Your diagnostic process may encompass the following:

A complete medical history. This will help us identify any current conditions that may be affecting your ability to get and maintain an erection — or that might affect your treatment going forward. We’ll also discuss the effects your current medications might be having as well.

Sexual history. Documenting your sexual history is important. We’ll want to learn about the duration and severity of your ED: how long it’s been occurring, your libido and ability to ejaculate, and whether you have any other sexual dysfunction (premature ejaculation, say) that might be affecting your performance.

Physical examination. A targeted urologic exam is essential to evaluate ED. The exam will consider your secondary sexual characteristics and look for signs of cardiovascular, endocrinological and neurological disease. An examination of the penis, testicles and prostate gland may be necessary as well.

Lab testing. Which tests are needed will depend largely on your medical history. We might conduct a fasting glucose test to rule out your ED being a side effect of diabetes mellitus; a lipid profile or more extensive cardiovascular tests can rule out underlying vascular conditions. We’ll also evaluate your kidney, liver and thyroid function.

Hormonal investigation. Testosterone deficiency is one common yet often overlooked cause of ED, and Obsidian’s urologists are experts at diagnosing and managing it. We’ll do advanced lab testing to exclude subtle testosterone deficiency, including measurements of bioavailable and free testosterone. Should treatment be necessary, we’ll correct your testosterone deficiency aggressively but safely.

Vascular evaluation. In order to evaluate blood flow to the penis, a penile injection using vasoactive agents is sometimes necessary, followed by audiovisual or partner stimulation with follow-up observation. Ultrasound can also assess the penile arteries to determine the presence of a blockage.

Neurologic testing. If we suspect neurologic disease, we might conduct advanced neurologic evaluations — nocturnal-tumescence testing and nerve-conduction studies, for example.

Imaging. In complex cases, imaging of the pelvic arteries via arteriography may be necessary to identify a blockage that might be suitable for surgical repair. If venous leakage is suspected, a penis imaging called a “cavernosogram” will help us identify its source.

Referral to other specialists. Our diagnostics may reveal certain conditions — cardiological, hematological or psychological — for which we’ll refer you to additional specialists.

In all cases, once your evaluation is complete, our experts will devise a treatment plan appropriate for you.


Give us a call at 703-940-5815, or request a consultation today.


Erectile Dysfunction FAQ

Have more questions about ED and Obsidian’s approach? Take a look at our Erectile Dysfunction FAQ.