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In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion w...

Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain an erection sufficient to permit satisfactory sexual intercourse. ED may result from psychological, neurologic, hormonal, vascular, or impairment of cavernosal smooth muscle function. The last 3 decades have witnessed a phenomenal improvement in diagnosis and treatment of ED. In the current chapter we review contemporary medical and surgical treatments for ED and novel therapies in development.

Integrative management of erectile disorder (ED) includes focused attention on both medical and psychosocial factors. Recent changes to the psychiatric diagnostic criteria for ED reflect an increasingly quantitative nosology and a shift towards an integrative view of biopsychosocial factors. This article outlines recent research that provides evidence for involving the patient’s partner, where possible, in a patient-centered model for the management of ED. Diagnostic challenges, including possible deficits in physician training and comfort in dealing with ED, are identified, and key elements of an integrative sexual status examination are described. Process-of-care standards for evidence-based practice serve to highlight the importance of integrative treatment. A treatment algorithm—based on these evidence-based guidelines and recent research on integrative and combinative practice—is provided, followed by a discussion of areas of focus for future research.

The paper presents research data on the functional assessment erectile dysfunction in middleaged men with chronic prostatitis. Identified singns indicate significant effects of chronic prostatitis on erectile disorder

References to priapism as a trivial erection problem misrepresent its importance as a true clinical disorder of male sexual function. The presumably limited frequency and population extent of this disorder largely influences this misconception, although its pathophysiologic obscurity, the dearth of remedies for it, and its self-remitting tendency also are contributing factors in this regard. Unlike the widespread emphasis placed on male erectile dysfunction (ED), less attention has historically been given to priapism despite this erectile disorder also carrying adverse health risks. It is therefore heartening to observe that, at this time when recent advances have been made in the scientific understanding and clinical practice of male ED, a similar aim toward establishing effective, evidence-based therapeutics for priapism is gaining momentum. This article reviews recent clinical developments in the medical and surgical management of priapism and surveys scientific research activity in this rapidly evolving field of study that conceivably will pave the way for further innovations in its treatment. In addition, the relevance of health care administration and policy to this field is evaluated, particularly as this area relates to the sickle cell disease population, and some health care programmatic areas are proposed for improving health outcomes of individuals with priapism.

The aim of this research was to study the morphologic characteristic of penis elastic fibers in patients with erectile dysfunction (ED) and Peyronies disease (PD) by morphometric methods. Taken material was penis biopsy of 23 patients with ED and 9 patients with PD. Elastic fibers were tudied with the help of resorcinfuchsin by Veigerts and Vergofs methods. The qualitative changes of elastic fibers such as bifurcation of fibers, decolorization, cob formation, fiber thinning combining with structure thickening were detected. The decreasing of elastic fibers quantity in tunica albuginea and corpus cavernosa of penis in patients with ED and PD was noted. These elastic fibers can not be considered as physiologic fibers because they dont make their function. Their malfunction and their increasing in tissue of penis evidently lead to the deterioration of penis elasticity and erectile disorder

Priapism, a pathologic condition of persistent penile erection in the absence of sexual excitation, is a true erectile disorder. Although it may seem to affect only a small population of male individuals, it carries major significance. Possible complications of the disorder include penile fibrosis and permanent erectile dysfunction. All health care professionals should appreciate the importance of the disorder and be prepared to follow current principles of diagnosis and treatment to reduce or avert its complications.

This study by Sangan Sookdeb explored the factors that determine the time interval between men suffering the onset of erectile disorder and their presentation for treatment. As prognosis is considered to be related negatively to the length of time a man suffers erectile disorder understanding factors that delay presentation may identify changes in practice methods that will encourage earlier presentation.

The comparison of results of previous studies on the prevalence of erectile dysfunction is hampered due to differences in study design and research instruments including definitions used. The aim of the study was to determine the prevalence of erectile dysfunction/erectile disorder (ED) using different definitions. An epidemiological cross-sectional study was conducted between May and November 2002 in Berlin, Germany. A total of 6000 men between 40 and 79 years of age were randomly selected by the Berlin Office of Vital Statistics and were sent a questionnaire by mail. The prevalence of ED was determined using five different methods. A total of 1915 questionnaires were eligible for analysis. The five different definitions yielded age-adjusted ED prevalence rates between 18 and 48%. Age was strongly correlated with all five definitions (P0.001). These results indicate the need for standardized criteria when conducting future studies on ED and may aid in designing public health and clinical management strategies.

Venoocclusive disorder, also known as venous leak and anticipatory anxiety, are both common causes of erectile disorder. The clinical presentation and investigations using ultrasonography have some common findings during the preliminary assessment process. We present a treatment approach which may be offered in both conditions and which may require reduced doses or eventually allow withdrawal off medication. The Sheffield PDE5i and Ring Duo Technique uses maximum tolerated doses of sildenafil, tadalafil or vardenafil alongside penoscrotal rings to secure reliable and cosmetically aesthetic erections.

In recent years, the use of RigiScan and ultrasound to assess erectile dysfunction has fallen from favour. However, in a small minority of specialist cases, where a vascular, neurogenic or psychogenic aetiology requires confirmation, there remains a need for further investigation. To establish if in a preliminary assessment the use of nocturnal RigiScan or male impotence diagnostic ultrasound system (MIDUS) represents best practice as a diagnostic investigation in patients with a history suggestive of vascular organic erectile disorder. Men attending both urological and psychosexual therapy clinics with erectile dysfunction were assessed using a generic assessment schedule. Patients with a history suggestive of vascular erectile disorder were offered the opportunity of dual investigation of their condition. After screening using a provocative RigiScan using visual stimuli that gleaned inconclusive results, patients were offered the chance to enter a study with both nocturnal RigiScan and MIDUS investigation. These were confined for the purposes of this study to RigiScan events, peak systolic flow velocity (PSV) and end-diastolic flow velocity (EDV) from ultrasound examination where an abnormal EDV is defined as in excess of 4.5 cm/s and a normal PSV is variously defined as being greater than 35 cm/s. In all, 38/43 (88%, 95% CI: 76-95%) of men had a nocturnal event exceeding 3 min on the RigiScan investigation. This compares with 17/43 (40%, 95% CI: 26-54%) of men with a normal EDV blood flow of less than 4.5 cm/s (P

Priapism, particularly ischemic priapism, is uncommon in the general male population, but frequently occurs in men with hematologic dyscrasias such as sickle cell disease. In this review, Arthur Burnett focuses on the management of ischemic priapism, and stresses the need for prompt treatment in order to preserve erectile function in this group of men. Priapism is defined as a genuine erectile disorder, in which erection persists uncontrollably without sexual purpose. This disorder is often overlooked in comparison to other male sexual dysfunctions, principally because of its seeming rarity. Priapism, however, occurs frequently in certain patient populations, including those with hematologic dyscrasias. Most commonly, priapism affects patients with sickle cell disease. The reported prevalence rate in this group ranges between 29% and 42% of males. The significance of priapism is further emphasized by the fact that this disorder commonly causes erectile tissue damage and leads to the loss of functional erections. These observations highlight the need for proper clinical recognition of priapism in order to enable appropriate management. Here, the current knowledge of priapism as it relates to hematologic and coagulative diseases is discussed, with a focus on the diagnosis and treatment of the disorder.

Priapism, in which penile erection persists in the absence of sexual excitation, is an enigmatic yet devastating erectile disorder. Current endeavors to manage the disorder suffer from a poor fundamental knowledge of the etiology and pathogenesis of priapism. These endeavors have remained essentially reactive, which commonly fail to avert its pathological consequences of erectile tissue damage and erectile disability, not to mention its psychological toll. The role of preventative management seems paramount with respect to priapism. As a prerequisite to formulating prevention strategies, gaining understanding of its pathogenic features and likely pathophysiologic mechanisms is viewed to be quite important. This review combined an analysis of clinicopathologic reports as well as a summary of clinical and basic science investigations on the subject to date. These assessments support the basic classification of priapism into low-flow (ischemic) and high-flow (nonischemic) hemodynamic categories, resulting from venous outflow occlusion and unregulated arterial overflow of the penis, respectively. In addition, consistent with the hypothesis that dysregulative physiology of penile erection accounts for some presentations of priapism, several plausible molecular mechanisms influencing the functional state of the erectile tissue are discussed. Current progress in the field suggests prevention possibilities using androgenic suppressive therapy, adrenergic agonist therapies, and effectors of the nitric oxide-dependent erection regulatory pathway in the penis. New ideas for prevention may emerge from targeting molecular mechanisms involved in regulating erectile tissue function.

Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389–408, 1990). Community samples indicate a current prevalence of 0%–3% for male orgasmic disorder, 0%–5% for erectile disorder, and 0%–3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%–10% for female orgasmic disorder and 4%–5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.

Can perfectionism contribute to marital and sexual dysfunction? The examination of a range of variables that may have an effect between degrees of perfectionism in a man or his partner and marital satisfaction and sexual functioning is reported (MARTEN DI BARTOLO, P. & BARLOW, D.H. (1996) Perfectionism, marital satisfaction and contributing factors to sexual dysfunction in men with erectile disorder and their spouses, Archives of Sexual Behavior, 25, pp. 581-588). Perfectionism was measured using the Multidimensional Perfectionism Scale (MPS) and measure of marital satisfaction by the Dyadic Adjustment Scale (DAS). Rating scores of organicity and psychogenicity contribution towards erectile dysfunction using various criteria and different clinicians for each rating were obtained. Higher overall levels of perfectionism were found to be associated with high clinician ratings with regard to the influence of psychogenic variables in contributing to dysfunctional men's erectile difficulties. Neither d...

Intracavernosal injection therapy is now extensively used in the treatment of erectile disorder. It is effective in promoting erectile function in at least 80% of unselected patients. Overall, there is an extensive literature on this approach to treatment but the majority of papers relate to pharmacological, urologic or mechanistic issues. Reported studies that include psychological and behavioural aspects are scattered thinly throughout the literature. This paper attempts to review these aspects of intracavernosal injection therapy and emphasizes the desirability of the combined sex therapy-intracavernosal injection approach to the management of erectile disorder.

The fundamental need for psychodynamic clinical interventions in most cases of sexual dysfunction has never been denied. Equally, specific clinical interventions of a physiodynamic nature are a fundamental part of the richness of treatment resources in most cases of erectile dysfunction. In recent years, in the presence of uncertainties about the long-lasting therapeutic effects of exclusive methodology, advocacy for a professional approach in favour of the use of integrative systems in the treatment of sexual dysfunction has been strong. The practitioner of sexual and relationship psychotherapy, whatever his or her base discipline, is required in the name of therapeutic effectiveness to consider the psychological and the organic when establishing a plan of treatment. This is particularly true in the case of male erectile dysfunction, the most common of all sexual arousal disorders. This paper considers the role of Vacuum Constriction Devices (VCDs) in terms of their biopsychosocial cause and eff...

Treatment outcome was studied in 37 couples who entered brief combined sex and relationship therapy for male erectile disorder in a specialized clinic. Treatment was completed by nearly two thirds of the couples. Significant improvements in target symptoms, questionnaire scores, including the Golombok Rust Inventory of Sexual Satisfaction, and frequency of attempts at sexual activity were recorded. Results suggest that behavioral-systems couple therapy and modified modern sex therapy offer a brief, flexible, and reproducible treatment option for men with psychogenic factors associated with erectile disorder.

Since decreased serum levels of testosterone (T) do not necessarily predict good outcome of testosterone treatment for erectile disorder, the purpose, of this study was to determine which men with erectile disorder and decreased serum levels might benefit from treatment. From a sample of 31 men(\({\bar x}\)age = 39 years), 15 (48%) with erectile disorder and decreased serum levels of T responded well after 8 weeks of testosterone treatment (100 mg of testosterone propionate in the sustained-release form given im once a week). Good treatment outcome was associated with several variables, but only high levels of luteinizing hormone (LH) and low values of the T/LH (testosterone/LH) ratio consistently emerged as significant correlates and/or predictors of effective treatment. Levels of LH above 7.5 IU/L or the values of the T/LH ratio equal to or below 0.87 nmol/IU in patients with erectile disorder and decreased serum levels of T suggest that testosterone treatment may be effective.

Die Erektionsstörung (EDi), definiert als die anhaltende Unfähigkeit, eine adäquate Erektion zu erlangen, oder für eine befriedigende sexuelle Aktivität aufrecht zu erhalten, ist die zweithäufigste Sexualfunktions-Störung des Mannes (3, 4). Seit es immer mehr wissenschaftliche Arbeiten zur Prävalenz der Erektionsstörung gibt, steigen parallel dazu auch die Betrachtungsansätze, was deren Ursache betrifft. Unterschied man zu Beginn hierbei noch zwischen organischen und psychischen Ursachen, beginnt man langsam zu hinterfragen, ob hierbei nicht ein unmittelbares Ineinandergreifen vorliegen könnte (5). Parallel hierzu erregte ein weiteres gesellschaftliches Tabuthema wissenschaftliches Interesse, die sexuelle Präferenzstörung. In der Vergangenheit durchgeführte epidemiologische Studien legten nun den Verdacht nahe, ob nicht zwischen genau diesen beiden Tabuthemata Zusammenhänge bestehen könnten (8, 39). Jedoch wurde bis dato keine Analyse der Zusammenhänge zwischen Sexualität und der partnerschaftlichen Situation durchgeführt. Mittels des angepassten Fragebogens zum sexuellen Erleben und Verhalten (FSEV) wurden in einer standardisierten Interviewarbeit 46 Patienten, die zwischen Februar und September 2010 die andrologische Sprechstunde der Charité in Berlin Mitte besuchten und gleichzeitig an einer EDi litten, zu ihrer sexuellen Funktion, ihrer sexuellen Präferenz und ihrer partnerschaftlichen Zufriedenheit befragt (46). Ziel der Befragung war es, mögliche Korrelationen zwischen sexuellen Funktionsstörungen und sexuellen Präferenzstörungen herauszuarbeiten und deren Auswirkungen auf die partnerschaftliche Situation zu thematisieren. Die so gesammelten Daten wurden in eine digitale Rohdatenbank eingegeben und mit Hilfe deskriptiver statistischer Methoden ausgewertet. Zur Überprüfung der aufgestellten Hypothese, dass ein hoher Ausprägungsgrad an EDi mit einem hohen Ausprägungsgrad sexueller Präferenzstörungen einhergehe und, dass eine stark ausgeprägte paraphile Ansprechbarkeit/Paraphilie mit Leidensdruck sich auf die partnerschaftliche Situation auswirkt, wurde der Rangkorrelationskoeffizient Kendalls τb für ordinal skalierte Merkmale angewendet. Es zeigte sich, dass von den 46 befragten Patienten 36 tatsächlich an einer Erektionsstörung (EDi) im Sinne der Definition litten. Von diesen gaben 10 an keine paraphile Ansprechbarkeit vorzuweisen, 26 bejahten eine paraphile Ansprechbarkeit. Von diesen 26 konnten im Sinne der Definition 8 als Paraphile mit Leidensdruck identifiziert werden. Wie bereits in der Berliner Männerstudie (3) festgestellt wurde, konnten als häufigste Erregungsmuster Voyeurismus, Sadismus/Masochismus und Fetischismus festgestellt werden und im Rahmen dieser ebenfalls sehr häufig eine Vorliebe für „spezielle sexuelle Praktiken“ erfasst werden. Es fanden sich insgesamt 8 pädophil/hebephil orientierte Studienteilnehmer, die an EDi litten. Somit sollte überlegt werden, die Urologie, bzw. Andrologie als solche als neuen Ansatzpunkt zum Herausfiltern pädophil orientierter Männer zu betrachten. Bei der Korrelationsanalyse ergab sich ein tendenziell negativer Zusammenhang zwischen dem Schweregrad einer EDi und dem Ausprägungsgrad paraphiler Ansprechbarkeit/einer Paraphilie mit Leidensdruck. Das bedeutet, dass sich eher schwere Erektionsstörungen bei Patienten mit geringer sexueller Neigungsausprägung detektieren ließen. Es zeigte sich auch eine statistisch nahezu signifikante vermehrte partnerschaftliche Unzufriedenheit bei Patienten mit stärker ausgeprägter Paraphilie mit Leidensdruck. Daher sollten mehr Hypothesen bzgl. partnerschaftlicher Bindungssituation und Vorliegen einer sexuellen Präferenzstörung erhoben und geprüft werden, um multiple Ansätze in der Therapie sexueller Funktionsstörungen gewährleisten zu können, da sich eine belastete partnerschaftliche Beziehung an sich schon negativ auf die sexuelle Funktion auswirken kann. Denn nur innerhalb der Paarstruktur kann eine erfolgreiche Therapie sexueller Präferenzstörungen, die mit sexuellen Funktionsstörungen verbunden sind, stattfinden. Die Ergebnisse dieser Studie sollten mit Hinblick auf die kleine Stichprobe, den gewählten Studientyp und das besondere Patientenkollektiv betrachtet werden., Clinical experience over the last decades shows that sexual preference disorders can lead to sexual dysfunction. They might also affect partnership and sexual life in a negative way. Although this is a common theory in sexual medicine, nearly no data has been analyzed in this context so far. This study explores the association between erectile disorder and sexual paraphilias and their influence on an existing partnership in men who sought help in a urologic outpatient clinic of the Charité Berlin for their erectile disorder. These men took part in face-to-face interviews and completed the „Fragebogen zum sexuellen Erleben und Verhalten“ (FSEV) questionnaire. We found that the majority of these patients (N = 36) presented either with a paraphilia without significant strain (N = 18) or with significant strain ( N= 8). This fact alone is outstanding, because 15 out of 36 patients reported sexual preferences with potential endangerment to others (i.e. Exhibitionism, Frotteurism, Pedophilia, Hebephilia). These outcomes suggest that there are needs for specially addressing these problems within the urological/andrological evaluation. Correlations indicated that there are less relations between severity of an erectile disorder, than between the dimension of an impairment of the partnership and the severity of a sexual preference disorder. The patients even seemed to be more compromised by their impaired relationship status, than by the mere erectile disorder. So within a relationship, there are therapeutically possibilities, to work both on a sexual dysfunction and on the sexual preference disorder.

The relationship among perfectionism, marital satisfaction, and male sexual functioning was examined. Thirty-two men with DSM-III-R erectile disorder participated. Of this group, 18 men had spouses who were able/willing to participate in their assessment. Subjects completed the Multidimensional Perfectionism Scale (MPS) as well as the Dyadic Adjustment Scale (DAS), a measure of marital satisfaction. Additionally, physician ratings of organic contribution to the sexual dysfunction as well as clinician ratings reflecting the degree to which dysfunctional males' sexual difficulties were due to psychogenic factors were assigned. Psychogenic ratings were significantly positively correlated with overall MPS scores, whereas organic ratings were not. No significant group differences were detected on any measure among those whose spouses participated and those who did not have spouses or whose spouses were unable/unwilling to participate. In addition, for the subset of this sample that included dysfunctional men and their spouses (n = 18), results indicated that DAS scores for both dysfunctional men and their spouses were unrelated to clinician psychogenic ratings and physician organic ratings with the exception of a significant positive relationship between men's DAS scores and their organic ratings. It was revealed that women's, but not men's, total MPS scores were negatively related to both their own and their partner's DAS scores. Implications of these findings for the treatment of sexual dysfunction are discussed.

We provide a comprehensive review of the empirical literature regarding the prevalence of erectile disorder among men with diabetes mellitus. Estimates have varied from 7–85%, depending on sample c...

This paper explores the range of psychosexual problems identified in people with HIV infection and AIDS. It includes problems related to sexuality or the need to discuss sexuality with others. Erectile disorder and reduced sexual drive are sometimes presented. Many individuals experience sexual relationship difficulties generally and specific problems associated with the adoption and maintenance of safer sexual behaviours. Such maintenance is a long-term problem. Discussion surrounding procreation is relevant for all clients, irrespective of their sexuality. Other sexually transmitted diseases may facilitate transmission and disease progression and hence enter the HIV arena. Lastly, sex for money, and rape are discussed. An intervention study is briefly described in an attempt to quantify the range and extent of psychosexual problems arising during counselling and the efficacy of counselling training in these skills for non-mental health staff working with AIDS and HIV positive clients. Short tra...

Sociocultural influence on sexual behavior is beyond doubt. It is difficult to attribute the wide range of different sexual behaviors in different societies to constitutional predisposition only. This study represents an open longitudinal prospective to collect sociodemographics as well as relevant medical data from all patients, attending a psychiatric clinic in a general psychiatric hospital, complaining of psychogenic sexual dysfunctions in a period of one year. Patients were selected only if organic causes for their dysfunctions were excluded and positive psychogenic factors were identified. A total of 38 male and 5 female patients were seen during this period. Twenty-five males had erectile disorder and the remaining 13 had premature ejaculation. Among the females, 2 had vaginismus and 3 had dyspareunia. Eighty-eight percent of the male patients were younger than 40 years and married for less than 5 years. The premature ejaculators were relatively older than the impotents (85% older than 40 years). T...

Increasing therapeutic options available for the treatment of erectile disorder and the earlier identification of the problem in elderly patients has led to an increase in demand for treatment. While a decline in sexual function and desire can be expected with increasing age, little information exists on normal levels of sexual activity in the UK in the elderly male patient. One hundred consecutive unselected urological patients over 60 awaiting urlogical surgery were interviewed in detail to determine their sexual function. Results show an average age of 70 with 35% having had sex within the past year. Fifty-four percent of patients aged between 60 and 69 who had partners had had sex within the last two months. Twenty-nine percent had complete erectile failure while 9% were dissatisfied with their sex lives. We have shown that while sexual function decreases with age a significant percentage of patients over 60 remain sexually active. Although the vast majority are happy with their sex lives 9% ...

Erection obtained with a vacuum pump can be a solution for the impotent man. In this study it was proposed to and discussed with couples, eleven of whom chose it as treatment. The mean age of the men was 54 years and 8 months. The estimated etiology of their erectile disorder was: biogenic, 4, mixed, 7. A 25-item questionnaire was administered to each couple. Results show that the device was a good solution and improved the sex life of both partners. They manifested a fair degree of satisfaction with its use. The presence and the participation of the female partner should be considered in therapeutic recommendations for erectile disorders.

The association between sexual disorders and psychological functioning was investigated in this study. Seventy-eight subjects who applied for sex therapy were divided into the following groups: Sexual Desire (SDD) and Erectile Disorder; Orgasm (ORG) and Premature ejaculation (PME) disorders. Fifty-six sexually functional subjects served as matched controls. The MMPI was administered to all subjects. The results indicated that the SDD and Erectile groups produced the most disturbed profiles, while the ORG and PME groups yielded profiles within normal limit (WNL). A good fit of individual to group profiles was found for SDD, but not for PME and ORG; thus, clinical interpretation was possible for the former only.

Sex therapy in China has developed over the past three years, despite being largely unknown by the public and many clinical practitioners. This paper describes a short-term, comprehensive sex therapy, employing cognitive-behavioural techniques which were used to treat 21 couples with erectile dysfunction, where the remission rate was 61.8%. The authors believe that the technique of couple evaluation proved to be an objective measure of change. There was a close relationship between the outcome of therapy and the following factors: the course of therapy, the wife's attitude to sex, the level of the patients' psychosocial problems, and the state of the marriage itself.

This chapter discusses the deliberate omissions of arguments and propositions related to various aspects of sexual behavior in the book. Many arguments that could have been made in support for a proposition were not made in the book, whereas sometimes arguments that could have been made against a proposition were not made. It states that the arguments of natural selection and selective pressure in case of reproductive behaviors have not been presented in the text. Moreover, the presentation of incentive motivation theory is superficial, whereas description of copulatory behaviors lacks in several aspects. Furthermore, the text covers only a few of the sexual dysfunctions or disorders. The important sexual dysfunctions omitted include the sexual arousal disorders in women, erectile disorder in men, vaginismus, dyspareunia, premature ejaculation, and anorgasmia.

Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process, and we have little information on the etiology and pathophysiology of this erectile disorder. Two main types of priapism exist: low-flow (ischemic) and high-flow (nonischemic) priapism. When the physician first diagnoses which type of priapism exists, distinguishing the type of priapic event is paramount in order to choose the correct treatment options. Until recently, we had not sufficiently understood the pathogenesis of this erectile disorder and therefore, could not effectively manage its pathologic consequences of erectile tissue damage and erectile dysfunction. In this review, the proposed pathogenesis of ischemic priapism is reviewed, and a survey regarding novel treatment modalities is given.

Background: The objective was to collect characteristics of patients with male erectile disorder (MED) attending a male sexual dysfunction clinic and determine the level of psychological morbidity whilst recruiting subjects into a psychotherapy study. Methods: This was a study of data of 132 patients diagnosed as having male erectile disorder who attended a sexual problems assessment clinic. Men with a psychological component to their condition who accepted couple therapy were compared with those who refused such a treatment as well as with the group of men who were diagnosed as having an organic basis for their condition. All male attendees at the sexual dysfunction clinic over a ten month period were reviewed. The proportion of men with psychogenic factors contributing to the MED and who choose psychological therapy were noted as were demographic factors correlating with accepting therapy. Findings: Psychogenic factors were found to contribute towards the erectile disorder in the majority of cases. 28% of this group accepted couple psychotherapy in preference to a physical treatment. A significant proportion of these couples had returned preliminary questionaries to the clinic and had attended the assessment together. A younger age of onset of the problem for the man; a younger age of his partner; a shorter duration of the relationship together and not being married were all associated with accepting couple psychotherapy in preference to other treatments. Conclusions: Psychogenic factors are contributory in a majority of cases of erectile dysfunction. Epidemiological factors are identified in a group of men with MED. Where couple psychotherapy is indicated, certain factors are suggestive of patients who will accept such an option. Patient preference for a treatment option may play an important role in the outcome of therapy.

The results of four independent yet convergent meta-analyses to examine the efficacy of yohimbine in the treatment of erectile disorder are reported. These meta-analyses integrated data from (i) controlled clinical trials of yohimbine (when used alone), (ii) uncontrolled trials examining yohimbine (alone), (iii) controlled trials of yohimbine when used in combination with other drugs, and (iv) uncontrolled trials of yohimbine plus other drugs. Results document a consistent tendency for yohimbine, and for other medications containing yohimbine, to enhance erectile functioning relative to placebo. We also identify methodological and reporting difficulties that characterize much of the literature.

The present study concerned the evaluation of personality traits associated with sexual dysfunctions. The MMPI was used as a psychodiagnostic tool in male subjects (N = 37) with erectile disorder or premature ejaculation. The results tend to support some clinical observations based upon the cognitive-behavioral approach and some neurophvsioloeical data.

This book mainly describes organic aspects of the etiology, diagnosis, and treatment of erectile disorders. It is in this domain that most progress has taken place in recent years: research into the anatomy and physiology of the penis, new diagnostic tests, and modern physical therapies. As a consequence of these developments, it has become clear that organic factors play a role in the etiology of erectile disturbances much more often than was believed for many years. That is why one is justified in paying so much attention to the organic aspects of erectile dysfunctions. Yet, in doing this one should not lose sight of the psychosexological factors, as many erectile disorders are completely psychogenic in origin. Moreover, psychosocial or psychiatric factors always play a more or less important role in the pathogenesis and treatment of erectile disturbances, even if one has found a satisfactory organic explanation for the cause of the disorder. This chapter, therefore, presents an up-to-date review of the prevalence, classification, etiology, pathogenesis, diagnosis, and therapy of erectile dysfunction from the point of view of a psychiatrist-sexologist.

The majority of cases of genital self-mutilation reported in the literature have been in patients with psychosis. We report an unusual case of genital self-mutilation in erectile disorder. It is suggested that genital self-mutilation may be a pathway out of diverse psychological disorders and in non-psychotic cases it could be an expression of a psychotic solution to a conflict and may be influenced by cultural factors.

During a protocol study for the efficacy of fluparoxan (a noradrenergic α2-antagonist) in depression, a positive effect on male erectile impotence has been observed in one case, with no important secondary effects. This result confirms the involvement of α2-antagonists in the handling of male impotence. The action on the erectile disorder appeared slightly before the antidepressive effect (2-3 weeks) and lasted for 6 weeks after the discontinuation of treatment, suggesting that the effects on impotence were not a mere reflection of the antidepressive action.

The author, a psychiatrist and sexologist, gives an up-to-date review of the causation and management of erectile disorders. A classification of the various subtypes is presented. The etiology, pathogenesis, and diagnosis are discussed, with emphasis upon the interplay between organic and psychological factors causing and maintaining the erectile dysfunction. Both the general psychological approach and the modern sex therapies are briefly described. The psychological and sexological aspects of the implantation of an erectile prosthesis are discussed.

The purpose of this study was to develop and validate the Sexual Self-Efficacy Scale (SSES-E) for erectile disorder. The subjects consisted of 15 heterosexual couples with nonproblematic sexual functioning (normal group) and a sexually dysfunctional sample consisting of nine heterosexual couples and eight heterosexual single males (dysfunctional group). Most of the males in the dysfunctional sample were diagnosed as suffering from erectile disorder. Reliability of the SSES-E, based on test-retest and split-half correlations and on item analyses, appears to be reasonable. Validity, measured in three different ways, is also acceptably high. Suggestions for the use of this instrument in clinical practice and for future research are made.

As a basis for my work I conceptualize erectile dysfunctions as having multiple and interacting etiological causes. The current and widespread claim of the preponderance of somatic causes seems to me just as biased as earlier assertions of dominant psychogenetic factors. For effective therapy a precise specification of all mental as well as somatic causative factors and their interactions is essential. Until and unless it has been evidenced that a man with an erectile disorder exclusively requires either psychotherapy or somatotherapy, exploration of potential causes with their immediate therapeutic consequences should remain in one hand and be applied in cooperation with the patient.