Male Erectile Disorder (302.72)

DSM-IV-TR criteria

• A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.
• B. The disturbance causes marked distress or interpersonal difficulty.
• C. The erectile dysfunction is not better accounted for by another Axis I disorder (other than a Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition
• Specify if:
  • Lifelong Type
  • Acquired Type
• Specify if:
  • Generalized Type
  • Situational Type
• Specify:
  • Due to Psychological Factors
  • Due to Combined Factors

Associated Features

• It is normal for older men to need more stimulation to gain an erection, and they may require more time in between erections too. However, older men should still be able to achieve erection and enjoy sex. When a man of any age, younger or older, cannot achieve an erection or maintain one long enough for sexual satisfaction for both partners, it is considered Erectile Dysfunction (ED).

• Child vs. adult presentation

• Premature ejaculation one form of ED can occur at any age, and it is a common disorder. The occurrence of Premature Ejaculation in men aged 18-30 is common, it but may also occur in conjunction secondary to impotence in men aged 45-65. The inability to achieve an erection and ED, in general, is more commonly seen in older men, and sexual function drastically declines after one reaches the age of 50. This disorder only occurs in men.

Gender and cultural differences in presentation

There is no significant data that supports major differences in premature ejaculation between races, however, recent surveys suggest some racial variation. An analysis by Laumann et al (1999), found that premature ejaculation was more prevalent in African American men (34%) than white men (29%) or Hispanics (27%).

Epidemiology

Approximately 5-20% of men have moderate-to-severe ED.

Etiology

The majority of these cases with this disorder have an organic etiology, most commonly vascular disease that decreases blood flow into the penis. Diabetes, Hypertension, and Artherosclerosis are associated and linked to causal explanations for ED. If a person’s hormones are imbalanced, it can result in ED as well. A few physical causes of ED are: excessive alcohol and tobacco use, fatigue, brain and spinal-cord injuries, Hypogonadism, liver or kidney failure, Multiple Sclerosis, Parkinson’s Disease, radiation therapy to the testicles, stroke, or some types of prostate or bladder surgeries. Emotions or feelings which can lead to ED are similar to those associated with Male Orgasmic Disorder and include: nervousness due to previous bad sexual experiences or prior episodes of impotence, stress from external situations (ie. work, school, or family), depression, crowding insecurities, being preoccupied, and thinking the partner is displaying negative reactions. Values and conceptions regarding what is perceived as a normal duration should be considered. Age is an important factor as well; as individuals age, they typically engage in less sexual activity for shorter durations. Some evolutionary theorists have posited that ED in older individuals may serve an evolutionary function; ED may reduce the chances that a genetically degenerated sperm will couple with an ovum (egg cell). Hence, ED may be a natural mechanism that, to an extent, safeguards the species from genetic anomalies.

Empirically supported treatments

• Testosterone supplements may be used for cases due to hormonal deficiency.
• The cause is usually due to lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, for example, diabetes.
• ED can, in many cases, be treated by drugs which are taken orally, injected, or as penile suppositories.
• Exercise, particularly aerobic exercise is an effective cheap treatment for erectile dysfunction.
• Alprostadil can be injected into the penis or inserted using a special applicator – usually just before sexual intercourse.
• A purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it.
• Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.
• One medication used to treat this disorder is Viazil. See how it works by clicking here.