PSYCHOLOGICAL-ASPECTS AT THE INTERFACE OF DIABETES AND ERECTILE DYSFUNCTION

Diabetes-related erectile dysfunction is regarded as the typical model of organic impotence, with recognized organic pathogenesis and severa l effective treatments (e.g., intracavernosal injections, vacuum pumps , and transurethral, topical, or oral medications). There has been a n eglect, however, of psychological factors that can affect the establis hment, maintenance, and management of diabetic impotence. The adoption of an either/or, organic versus psychogenic paradigm fails to conside r that psychology contributes to and can coexist with organicity. Five psychological issues affecting diabetic patients with erectile dysfun ction are discussed: 1) sexual desire, 2) relationship with the partne r, 3) development of complicating sexual problems, 4) willingness to s eek help for sexual difficulty, and 5) acceptance and compliance with prescribed treatments. The nature of sexual desire is presented as an amalgam of three variable components: drive, motive and wish. Diminish ed sexual desire often occurs in the impotent man and/or his partner. Partners may respond negatively, and sexual relationships tend to chan ge as impotence develops. Performance anxiety or premature ejaculation may be secondary complications. The unwillingness of men to seek help for sexual difficulty and their poor compliance with prescribed treat ments pose major obstacles to successful treatment. Continuing compreh ensive care of the diabetic man aims to identify erectile dysfunction at its earliest manifestations. Effective intervention can then be ins tituted, and problems associated with chronic difficulties can be avoi ded. Optimal management of diabetic erectile dysfunction is best achie ved by adopting an integrative treatment model that addresses the comp lex interplay of biological and psychological issues involved in sexua l behavior.