Is the recurrent
inability to achieve or maintain an adequate erection until completion
of sexual activity. It is not considered male erectile disorder
if it is merely an occasional problem or if it does not create
distress and interpersonal difficulty.
Chronically or repeatedly, the patient cannot get or keep an erection
sufficient to complete the sexual activity.
Except for another Sexual Dysfunction.
It is not directly caused by substance use (medication or drug
of abuse) or by a general medical condition.
It causes marked distress or interpersonal problems.
Associated
Features:
Mood
Disorders
Anxiety
Disorders
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate
against the following disorders which need to be ruled out to
establish a precise diagnosis.
Hypoactive
Sexual Desire Disorder
Cause:
It can be
due to psychological or a combination of psychological and physical
factors, and it can occur in most or just some settings. For some,
the onset occurs at a specific time in life (acquired) as in response
to a specific situation. For others, it may be of lifelong duration.
Erectile disorders may accompany a fear
of failure. Sometimes this disorder is present throughout life.
In many cases the erectile failure is intermittent and sometimes
dependent upon the type of partner or the quality of the relationship.
Treatment:
Psychosocial
factors are important in all forms of erectile dysfunction. Careful
attention to these issues and attempts to relieve sexual anxieties
should be a part of the therapeutic intervention for all patients
with erectile dysfunction. Psychotherapy and/or behavioral therapy
alone may be helpful for some patients in whom no organic cause
of erectile dysfunction is detected. Other forms of treatment
may involve:Injection of vasodilating drugs into the penis. penile
prosthesis or implants, vascular surgery and vacuum
device therapy.
The treatment
of sexual desire/aversion/arousal/pain/orgasm disorders generally
involves behavioral techniques.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
A trial of
androgen replacement may be worthwhile in men with low serum testosterone
levels if there are no other contraindications. In contrast, for
men who have normal testosterone levels, androgen therapy is inappropriate
and may carry significant health risks, especially in the situation
of unrecognized prostate cancer. If androgen therapy is indicated,
it should be given in the form of intramuscular injections of
testosterone enanthate or cypionate.
Medical
& Other:
Injection
of vasodilator substances into the corpora of the penis has provided
a new therapeutic technique for a variety of causes of erectile
dysfunction.
Vacuum constriction
devices may be effective at generating and maintaining erections
in many patients with erectile dysfunction and these appear to
have a low incidence of side effects.
Three forms
of penile prostheses are available for patients who fail with
or refuse other forms of therapy: semi rigid , malleable, and
inflatable.
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