Erectile Dysfunction Evaluation: What to Expect From the History, Exam, Blood Tests and a Telehealth Visit

By Ares Men's Health · Updated October 10, 2026

Short answer: An erectile dysfunction evaluation usually includes a sexual and medical history, a short questionnaire such as the SHIM, a review of medications, a physical check that may include blood pressure and weight, and blood tests such as testosterone, blood sugar and cholesterol. Much of this can be done by telehealth, with a blood draw at a local lab, though some exams may need an in-person visit.

Key takeaways

• A proper ED evaluation looks for the cause, not just a quick prescription, and it also screens for cardiovascular and metabolic problems.

• The SHIM (IIEF-5) is a five-question score from 5 to 25 that grades ED from severe to none.

• Blood tests commonly cover testosterone and markers of diabetes and cholesterol; your provider chooses which suit you.

• Telehealth handles history, questionnaires, medication review, lab ordering and results; a hands-on exam may still be needed in some cases.

• Preparation helps: bring your medication list, any recent labs and home blood-pressure readings.

Why an ED evaluation matters

Erectile dysfunction (ED) is common, treatable and rarely trivial. It can be caused by blood-vessel disease, diabetes, nerve problems, hormones, medications, stress or a combination of these. Because it can also be an early warning of heart or vascular disease, urologic guidelines recommend a structured evaluation rather than jumping straight to treatment.

The goal of an evaluation is to answer three questions: how severe is the problem, what is likely causing it, and is anything else going on that needs attention? Everything in the visit serves one of those three.

Step 1: the sexual and medical history

This is the most important part of the evaluation, and it can be done in a private video visit. Expect questions about:

• When it started and whether it came on suddenly or gradually

• How it behaves: do erections occur at night or in the morning, with a partner, during solo activity?

• Desire and satisfaction, including any drop in libido

• Other sexual symptoms, such as ejaculation or orgasm changes

• Health conditions: diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea, prostate or pelvic surgery, nerve conditions

• Lifestyle: smoking, alcohol, recreational drugs, exercise, sleep, stress

• Medications and supplements, including over-the-counter products

• Mood and relationships: anxiety, depression, performance worries

The pattern of your answers is often revealing. ED that appears suddenly or only in certain situations tends to point toward psychological factors, while gradual change with fewer morning erections tends to point toward physical causes, though the two often coexist.

Step 2: the SHIM questionnaire

Many providers use a short, validated questionnaire to grade ED. The most common is the Sexual Health Inventory for Men (SHIM), also known as the IIEF-5, a five-question version of the International Index of Erectile Function developed by Dr. Raymond Rosen and colleagues.

You answer five questions about the past six months, covering confidence in getting an erection, firmness, maintenance and satisfaction. Each is scored from 1 to 5, giving a total from 5 to 25.

SHIM total	What it suggests
22–25	No ED
17–21	Mild ED
12–16	Mild to moderate ED
8–11	Moderate ED
5–7	Severe ED

The score does not identify the cause. It gives you and your provider a common baseline to track change over time.

Step 3: the physical check

A full ED workup traditionally includes a physical examination. Depending on your age, history and symptoms, a clinician may check blood pressure, heart rate, weight and waist size, signs of hormone problems such as reduced body hair or breast tissue changes, and in many cases a genital and prostate examination.

Some measurements, such as blood pressure and weight, you can take at home and report during a video visit. A hands-on examination cannot be done by video. If your history suggests one is needed, a responsible telehealth provider will say so and recommend an in-person visit rather than skipping it.

Step 4: blood tests

Blood tests help find treatable contributors. Your provider decides which tests suit you, but commonly considered ones include:

• Total testosterone, sometimes with SHBG and albumin so free testosterone can be estimated, since low testosterone can contribute to low desire and ED

• Blood sugar or HbA1c, to look for diabetes or pre-diabetes

• Cholesterol and lipids, as a marker of cardiovascular risk

• Other markers, such as kidney, liver or thyroid tests, if your history suggests them

Testosterone varies through the day, so providers typically ask for an early-morning sample and repeat a low result before acting on it. Our guide to the testosterone blood test covers preparation, and our article on whether low testosterone can cause ED explains how the two relate.

Step 5: heart and vascular risk

Consensus recommendations, including the Princeton III guidelines, advise treating ED as a prompt to assess cardiovascular risk. Your provider will usually ask about chest pain, breathlessness on exertion and family history, and review blood pressure and cholesterol.

Treatment decisions also depend on your heart health. Some ED medicines are unsafe with nitrate medications used for chest pain, which is one reason an evaluation comes before any prescription.

Specialised tests: when are they needed?

Most men never need more than the steps above. A urologist may add specialised tests in certain situations, for example after pelvic trauma, when blood-flow problems are suspected and treatment has not worked, or before surgery. These can include ultrasound imaging of penile blood flow or overnight monitoring of erections. They are referred out rather than done in a routine telehealth visit.

What telehealth can and cannot do for ED

Telehealth is well suited to	May need an in-person visit
Sexual and medical history	Genital or prostate examination
SHIM questionnaire and symptom review	Suspected structural or surgical problems
Medication and risk-factor review	Injury, pain, curvature or other physical findings
Ordering bloodwork and reviewing results	Specialised blood-flow or nerve testing
Planning treatment and follow-up	Any red-flag symptoms

For many men a private video visit removes the main obstacle to getting help: embarrassment about walking into a clinic. It works best when the provider is candid about its limits.

Questions that feel awkward, and why providers ask them

Some questions in an ED evaluation can feel intrusive. Each has a clinical reason:

• "Do you wake with erections?" helps separate physical from psychological patterns.

• "How is your desire?" tells the provider whether a hormone check is worthwhile.

• "Do you use any recreational drugs or supplements?" because many affect blood flow or hormones.

• "How are things with your partner?" because stress and communication can drive or worsen ED.

• "Any chest pain or breathlessness?" because heart health influences safe treatment choices.

Providers hear these answers every day. Being direct gives you a better evaluation and a safer plan.

Warning signs that should not wait

Most ED can be evaluated on a routine basis, but some symptoms need prompt attention:

• Chest pain, shortness of breath or fainting, especially with exertion

• An erection lasting several hours that will not go away, which is a medical emergency

• Sudden onset after an injury to the pelvis, spine or genitals

• Pain, a new bend or a lump in the penis

• Blood in the urine or semen, or severe pelvic pain

Seek urgent in-person or emergency care for any of these rather than waiting for a scheduled video visit.

How to prepare for your visit

1. List your medications and supplements, with doses.

2. Gather any recent lab results or reports from other clinicians.

3. Take a few home blood-pressure readings if you have a cuff.

4. Write down your timeline: when it started, what has changed, what you have tried.

5. Complete the free screening at our Low-T screening page if low drive or fatigue are also present.

6. Find a private, quiet spot with a stable connection, and be in Florida during the visit.

How follow-up works

An evaluation is the start of a process, not a single appointment. Once treatment begins, a good provider schedules a follow-up to check how you are responding, whether side effects have appeared and whether anything needs adjusting. Repeat lab work may be ordered if low testosterone was part of the picture.

Keep notes between visits on what has changed and how you feel. Specific observations, such as how often morning erections occur or how confident you feel, help your provider fine-tune the plan far better than a general impression.

What happens after the evaluation

Once your history and results are reviewed, your provider explains the likely causes and your options. Depending on what is found, the plan may include treating an underlying condition, lifestyle changes, counselling, medication prescribed after the evaluation, treatment of low testosterone if it is confirmed and appropriate, or referral to a urologist.

At Ares Men's Health in Miami Lakes, care is consultation-first. ED is not sold as a standalone product with a checkout price; it begins with a structured evaluation by Brian Ruiz, APRN, FNP-BC, delivered by secure telehealth across Florida. See our erectile dysfunction treatment page for the full approach, and how a virtual visit works. Pricing is confirmed during your consultation.

Frequently asked questions

What tests are done to diagnose erectile dysfunction?

A typical workup includes a sexual and medical history, a questionnaire such as the SHIM, a review of medications, a physical check and blood tests that may include testosterone, blood sugar and cholesterol. Your provider selects the tests that fit your situation.

What is the SHIM score for erectile dysfunction?

The SHIM, or IIEF-5, is a five-question score from 5 to 25. Scores of 22 to 25 suggest no ED, 17 to 21 mild, 12 to 16 mild to moderate, 8 to 11 moderate and 5 to 7 severe.

Can an ED evaluation be done through telehealth?

Much of it can: history, questionnaires, medication review, ordering labs and reviewing results. A hands-on exam cannot be done by video, so some men are advised to complete part of the evaluation in person.

Do I need a physical exam for ED?

A complete evaluation often includes one, depending on your age, symptoms and history. Your provider will tell you if an in-person examination is needed.

Which blood tests are used for ED?

Commonly testosterone, sometimes with SHBG and albumin, plus markers such as blood sugar and cholesterol. Additional tests may be added if your history suggests them.

Why does my provider ask about my heart health?

Because ED can be an early sign of cardiovascular disease and because some ED medicines are unsafe with certain heart medications. Heart risk shapes both the evaluation and the treatment plan.

Will I need to see a urologist?

Not usually. Most men can be evaluated and managed without one. Referral is considered for injury, structural problems, treatment that is not working or when specialised testing is needed.

How should I prepare for an ED evaluation?

Bring a list of medications and supplements, recent lab results and any home blood-pressure readings, and write down when symptoms began and what has changed.

Is an ED evaluation confidential?

Yes. At Ares Men's Health care is delivered through secure, HIPAA-compliant telehealth, so your visit, labs and plan stay private.

Is an ED visit at Ares priced as a fixed package?

ED care at Ares is consultation-first and pricing is confirmed during your consultation rather than listed as a standalone product price.

Talk to a provider

If you are dealing with erection problems, a private evaluation is the right first step. Ares Men's Health offers discreet, provider-led telehealth for men across Florida, with bloodwork at a lab near you.

Take the free 60-second Low-T screening · Book a consultation · Call 754-335-8868 (Mon–Fri 9am–5pm).

Sources and further reading

1. Burnett AL, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200(3):633–641 (PubMed)

2. Rosen RC, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5). Int J Impot Res. 1999;11(6):319–326 (PubMed)

3. Nehra A, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8):766–778 (PubMed)

4. NIDDK: Erectile dysfunction — diagnosis and symptoms

5. Mayo Clinic: Erectile dysfunction — symptoms and causes

6. Cleveland Clinic: Erectile dysfunction

This article is educational and is not medical advice. An erectile dysfunction evaluation is individualized, and some steps require an in-person visit. Individual results vary.