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Your doctor may want you to undergo further evaluation, which may include something called a “nocturnal penile tumescence test.” This is to see whether you have erections during your sleep (see above). If your doctor suspects a problem with penile blood flow, you may need to undergo pulsed Doppler evaluation. This test uses high-resolution ultrasound to evaluate the arteries’ blood supply to the penis. Another test involves the injection of smooth muscle relaxants through a small needle directly into the penis; the idea here is to see whether an erection can be produced. If this shot doesn’t cause an erection, this is a good hint that there’s a vascular problem—trouble with arterial blood flow Sometimes during this test a man develops an erection but gradually loses it; this usually signifies that there’s a problem with the veins—they’re not shutting off the blood supply, so the blood is escaping from the penis, and thus the erection is failing.

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