Erectile dysfunction, also known as impotence, is a crippling problem for millions of men. Erectile dysfunction is the inability to achieve and/or maintain an erection of sufficient rigidity and duration to allow for satisfactory vaginal intercourse. The initiation and maintenance of erection is a complex interplay of vascular, neural, hormonal and psychological factors. A problem involving any or all of these components can cause impotence. Erectile dysfunction can affect men of all ages; but its incidence increases with age. An estimated 1.9% of all 40 year old men are impotent, compared to 25% of all 65-year-old men. These figures include both organic and psychogenic impotence.
While the incidence of erectile dysfunction has remained relatively constant, therapeutic advances and greater public awareness of the problem has increased the number of men seeking treatment. During the past 20 years, through numerous advances in our understanding of the basic pathophysiology of impotence, a new era in the diagnosis and treatment of impotence has dawned. Improved diagnostic procedures and effective medical and surgical therapy are now available.
Because impotence is a functional disease, diagnostic evaluation and treatment can be tailored according to the patient’s desires and his physical and mental condition. This approach is known as the patient’s goal-directed approach to the diagnosis and treatment of impotence
Erectile dysfunction affects men of all ages; but its incidence increases with age. In the 1950’s, 90% of cases of erectile dysfunction were believed to be psychogenic. Current belief is that 50% of impotent patients have and underlying organic disorder, and in the older population, the percentage is probably higher. After appropriate history, physical and diagnostic evaluation has established the probable diagnosis of psychogenic erectile dysfunction, an attempt at psychosexual therapy is indicated. Among the goals of sex therapy intervention are the correction of misinformation and myths, establishment of mutual responsibility for satisfaction and the elimination of interference in the form of performance demand or anxiety.
There are few controlled studies establishing the effectiveness of behavior therapy for functional erectile dysfunction. Patients are often resistant to referral. Seagraves reported that 38% of patients referred to psychiatry never contacted the clinic, and of those that did, 83 percent refused therapy or terminated therapy early. The establishment of a satellite psychiatry service in the urology clinic may lead to an improved rate of success.