Psychosomatic aspects in the diagnosis and treatment of erectile dysfunction

After a critical review of prevalence data, psychosocial determinants and p sychosomatic aspects in the diagnosis and treatment of erectile dysfunction are discussed (with reference to age-related changes). Widely used laborat ory assessments are responsive to psychological factors (e.g. anxiety). Inc lusion of the partner in the diagnostic process may change the clinical pic ture and the treatment recommendations considerably. As illustrated by peni le prosthetis treatment and self-injection of vasoactive substances, accept ance and success of widely used surgical and medical treatments depend larg ely upon the patient's expectations, and the adaptation of the couple to th e procedure. Even in cases with a clear organic pathology, fluctuations in erectile functioning may be attributable to psychological influences. As re cent psychotherapeutic and psychoeducational approaches underscore, erectil e failure is best conceived as a final common pathway of somatic, lifestyle , psychological and partnership determinants. These should be taken into ac count in comprehensive diagnostic and treatment formulations if the goal of therapy is not only to produce rigid erections, but to increase sexual sat isfaction.