Male Erectile Disorder

The essential feature of Male Erectile Disorder is a persistent or recurrent inability to attain, or to maintain an adequate erection during sexual intercourse.

The diagnostic criteria includes the following symptoms:

• Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.

• The disturbance causes marked distress or interpersonal difficulty.

• The sexual dysfunction is not better accounted for by another Axis I disorder (except another 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.

Subtypes

Subtypes are provided to indicate the onset, context, and etiological factors associated with the Sexual Dysfunctions.

Lifelong: This subtype applies if the sexual dysfunction has been present since the onset of sexual functioning.

Acquired: This subtype applies if the sexual dysfunction develops only after a period of normal functioning.

Generalized Type: This subtype applies if the sexual dysfunction develops only after a period of normal functioning.

Situational Type: This subtype applies if the sexual dysfunction is limited to certain types of stimulation, situations, or partners.

Due to Psychological Factors: This subtype applies when psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the Sexual Dysfunction, and general medical conditions and substances play no role in the etiology of the Sexual Dysfunction.

Due to Combined Factors:

This subtype applies when 1) psychological factors are judged to have a role in the onset, severity, exacerbation, or maintenance of the Sexual Dysfunction; and 2) a general medical condition or substance use is also judged to be contributory but is not sufficient to account for the Sexual Dysfunction.

If sexual dysfunction is attributed solely to substance abuse or a medical cause, Sexual Dysfunction Due to a General Medical and/or Substance-Induced Sexual Dysfunction is diagnosed.

Associated Features

The erectile difficulties in Male Erectile Disorder are frequently associated with sexual anxiety, fear of failure, concerns about sexual performance, and a decreased subjective sense of sexual excitement and pleasure.

Erectile dysfunction can disrupt existing marital or sexual relationships and may be the cause of unconsummated marriages and infertility. This disorder may be associated with Hypoactive Sexual Desire Disorder and Premature Ejaculation. Individuals with Mood Disorders and Substance-Related Disorders often report problems with sexual arousal.

Course

The various forms of Male Erectile Disorder follow different courses, and the age at onset varies substantially. The few individuals who have never been able to experience an erection of sufficient quality to complete sexual activity with a partner typically have a chronic, lifelong disorder. Acquired cases may remit spontaneously 15%–30% of the time. Situational cases may be dependent on a type of partner or the intensity or quality of the relationship and are episodic and frequently recurrent.

The loss of sexual desire may be continuous or episodic, depending on psychosocial or relationship factors. An episodic pattern of loss of sexual desire occurs in some individuals in relation to problems with intimacy and commitment.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.