PSYCHOGENIC ERECTILE DYSFUNCTION : Classification and Management - 03/09/11
Résumé |
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 Research22 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.32, 44 Psychogenic erectile dysfunction frequently coexists with other sexual dysfunctions, notably hypoactive sexual desire,28, 38 and with major psychiatric disorders, particularly depression and anxiety disorders.3, 5 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,11 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.3 Similar findings were reported in the National Health and Social Life Survey17 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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| Address reprint requests to Raymond C. Rosen, PhD, Department of Psychiatry, University of Medicine and Dentistry of New Jersey– Robert Wood Johnson Medical School 675 Hoes Lane, Piscataway, NJ 08854, e-mail: rosen@umdnj.edu |
Vol 28 - N° 2
P. 269-278 - mai 2001 Retour au numéro
Article précédent
- SMOOTH MUSCLE ELECROMYOGRAPHY
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