Male psychogenic erectile dysfunction in elder ages: a myth or truth?

ABSTRACT

In advanced ages, erectile dysfunction as an increasingly encountered problem was thought to be organic in nature. The existing work had investigated its main etiologic aspects in 40 males, aged 56.2-65.9 years, suffering from secondary erectile dysfunction. Clinical psychiatric, neurological, and urological assessments were implemented, and supported by basic hormonal assays, blood glucose and lipids, urine analysis, and intra cavernous prostavasine injection. Cutaneous perception threshold, EMG of bulbocavernous reflex, Doppler ultrasonography, penile-brachial index, cavernosometry, and covernosography were performed for suspected cases. Multifactorial causation was identified in 22.5% of cases combined psychological and organic determinants were seized in 22.5% of subjects. and predominantly psychogenic etiology was involved in 32.5% of patients-mainly as depressive disorders according to DSM -111-R. Erectile dysfunction was predominantly neurogenic in 2.5%. Predominantly venogenic in 20% and predminantly arteriogenic in 2.5% of patients. Sexual hormonal deficiency was identified in 2.5% and systemic causes, namely hypertension, were evident in 17.5% of the study sample, the same as that of cases with bimixed origins. Different working mechanisms were discussed, and the current work proposed a diagnostic and therapeutic decision making tree, and provided recommendations that might be useful in clinical management of such cases