Honeymoon impotence: Psychogenic or organic in origin?

Objectives. Honeymoon impotence is the inability to perform successful sexu al intercourse during the initial experience, especially during the first n ights of marriage, and it is relatively frequent in Turkey. We investigated the underlying penile vascular abnormalities in patients presenting with h oneymoon impotence and sought to differentiate between psychogenic and orga nic etiologies. Methods. Between 1989 and 1999, 90 patients sought urologic help for honeym oon impotence. Patient age ranged from 18 to 39 years (mean 28.06 +/- 3.4). All patients were given an intracavernous injection of 60 mg papaverine co mbined with self-manual genital stimulation (CIS test) to assess the degree of tumescence. Patients with a positive response to the CIS test were late r evaluated with nocturnal penile tumescence (NPT) monitoring. Patients wit h a negative response to the CIS test and/or NPT monitoring were evaluated further using penile color Doppler ultrasound. Results. A psychogenic etiology was found in 61 patients (67.7%), 50 (55.5% ) of whom achieved satisfactory sexual intercourse after intracavernous inj ection. Twenty-five patients (27.7%) exhibited penile vascular abnormalitie s by color Doppler ultrasound. Neurogenic erectile dysfunction was consider ed in the remaining 4 patients (4.4%) with a positive response to the CIS t est, abnormal findings on NPT monitoring, and a normal vascular system with color Doppler ultrasound. Conclusions. The present study is the first to report penile vascular abnor malities in patients presenting with honeymoon impotence, which was previou sly believed to be exclusively psychogenic in origin. The evaluation of the penile vascular system in patients with honeymoon impotence may reveal und erlying penile vascular abnormalities, allowing the choice of the appropria te therapeutic option. UROLOGY 57: 758-762, 2001. (C) 2001, Elsevier Scienc e Inc.