PSYCHOGENIC ERECTILE DYSFUNCTION

Classification and Management
  • Author Footnotes
    * Department of Psychiatry, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway, New Jersey
    Raymond C. Rosen
    Footnotes
    * Department of Psychiatry, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway, New Jersey
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  • Author Footnotes
    * Department of Psychiatry, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway, New Jersey
      Psychogenic erectile dysfunction is defined as the persistent inability to achieve or maintain erection satisfactory for sexual performance owing predominantly or exclusively to psychologic or interpersonal factors. This definition recently was adopted by the International Society of Impotence Research
      • LoPiccolo J.
      Postmodern sex therapy for erectile failure..
      and acknowledges three key components: (1) psychogenic erectile dysfunction is a positive diagnosis that should not be used when the etiology of the disorder is uncertain or unknown; (2) psychosocial factors should be identified as the predominant or exclusive cause of the patient's dysfunction, and patients with a combination of organic and psychogenic factors should be diagnosed as having mixed organic-psychogenic erectile dysfunction; and (3) other components of the definition are consistent with recent consensus definitions of erectile dysfunction.
      • The Process of Care Consensus Panel
      The process of care model for evaluation and treatment of erectile dysfunction.
      • Jardin A.
      • Wagner G.
      • Khoury S.
      • et al.
      Psychogenic erectile dysfunction frequently coexists with other sexual dysfunctions, notably hypoactive sexual desire,
      • O'Carroll R.
      Sexual desire disorders: A review of controlled treatment studies.
      • Segraves R.T.
      • Segraves K.B.
      Aging and drug effects on male sexuality..
      and with major psychiatric disorders, particularly depression and anxiety disorders.
      • Araujo A.B.
      • Durante R.
      • Feldman H.A.
      • et al.
      The relationship between depressive symptoms and male erectile dysfunction: Cross-sectional results from the Massachusetts Male Aging Study.
      • Barlow D.H.
      Causes of sexual dysfunction: The role of anxiety and cognitive interference.
      In the latter cases, a primary diagnosis may be difficult to establish, and concomitant treatment of the patient's psychiatric disorder may be indicated as the initial step in management.
      Epidemiologic studies have highlighted the prevalence of psychosocial factors in the etiology of erectile dysfunction. In the Massachusetts Male Aging Study,
      • Feldman H.A.
      • Goldstein I.
      • Hatzichristou D.G.
      • et al.
      Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study.
      erectile dysfunction was associated significantly with self-reported depressive symptoms (odds ratio [OR] = 2.88), pessimistic attitudes (OR = 3.89), or a negative outlook on life (OR = 2.30) (Table 1). Depressed mood was found to be a significant predictor of erectile dysfunction, even after controlling for potential confounding factors.
      • Araujo A.B.
      • Durante R.
      • Feldman H.A.
      • et al.
      The relationship between depressive symptoms and male erectile dysfunction: Cross-sectional results from the Massachusetts Male Aging Study.
      Similar findings were reported in the National Health and Social Life Survey
      • Lazarus A.A.
      The treatment of a sexually inadequate man..
      in which erectile dysfunction was significantly associated with self-reported emotional stress (OR = 3.56) and a history of sexual coercion (OR = 3.52). Socioeconomic factors, including a decrease in household income during the past 5 years, also were significantly associated with the incidence of erectile dysfunction. Overall, these studies underscore the independent and interactive effects of psychosocial factors in the etiology of erectile dysfunction.
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