DIAGNOSIS AND TREATMENT OF PSYCHOGENIC ERECTILE DYSFUNCTION IN A UROLOGICAL SETTING - OUTCOMES OF 18 CONSECUTIVE PATIENTS

The diagnostic criteria and treatment outcomes of 18 consecutive patie nts with psychogenic erectile dysfunction were examined. Average patie nt age was 38 years, and all patients had either awakening penile or m asturbatory rigidity. Each patient was studied with home monitoring (A RT-1000) on 2 consecutive nights. The average number of maximum erecti le episodes, the event during which the maximum rigidity was maintaine d for at least 5 minutes, was 1.6. The maximum sleep erectile episodes averaged 11.2 minutes during which penile rigidity averaged 572 gm. T he main predictor for remission of erectile dysfunction in this study was whether the dysfunction was primary or secondary. Of 14 patients w ith secondary psychogenic erectile dysfunction, that is history of bei ng able to achieve and maintain penile rigidity sufficient for at leas t 5 minutes of vaginal intercourse, 10 (71 %) experienced remission. T hree patients noticed spontaneous remission during the initial evaluat ion and another 3 experienced remission within 3 months of completion of the evaluation and reassurance that they had normal erectile capaci ty. Two patients had remission while considering penile vascular surge ry and in 2 normal erectile function returned during injection therapy . Only 2 of 3 patients referred for sex therapy actually received it ( Freudian theory), and neither noticed improvement in erectile function . One patient received yohimbine without benefit. None of the patients elected treatment with the vacuum constriction device. All 4 patients with primary psychogenic erectile dysfunction, that is never able to achieve and/or maintain penile rigidity sufficient to achieve vaginal intercourse, failed to respond to physician reassurance and time. Of 2 patients who received sex therapy (1 Freudian and 1 behavioral) witho ut improvement in erectile function 1 has entered the pharmacological erection program and has achieved vaginal penetration, and the other i s considering the pharmacological erection program. The remaining 2 pa tients have deferred all therapy. Based on this experience, we current ly reassure patients with secondary psychogenic erectile dysfunction t hat they have erectile capacity for sustained vaginal intercourse and schedule a followup visit in 3 months. Additional individualized thera py (pharmacological erection program, vacuum constriction device, sens ate focus/psychodynamic specific therapy or penile prosthesis) is offe red as needed and requested. Patients with primary psychogenic erectil e dysfunction are initially offered the pharmacological erection progr am or the vacuum constriction device and sex sensate focus/psychodynam ic specific therapy. The penile prosthesis is considered for treatment failures.