What are the DSM-5 criteria for diagnosis of erectile dysfunction (ED)?

Updated: Aug 08, 2018
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies erectile disorder as belonging to a group of sexual dysfunction disorders typically characterized by a clinically significant inability to respond sexually or to experience sexual pleasure. [8]

Sexual functioning involves a complex interaction among biologic, sociocultural, and psychological factors, and the complexity of this interaction makes it difficult to ascertain the clinical etiology of sexual dysfunction. Before any diagnosis of sexual dysfunction is made, problems that are explained by a nonsexual mental disorder or other stressors must first be addressed. Thus, in addition to the criteria for erectile disorder, the following must be considered:

  • Partner factors (eg, partner sexual problems or health issues)

  • Relationship factors (eg, communication problems, differing levels of desire for sexual activity, or partner violence)

  • Individual vulnerability factors (eg, history of sexual or emotional abuse, existing psychiatric conditions such as depression, or stressors such as job loss)

  • Cultural or religious factors (eg, inhibitions or conflicted attitudes regarding sexuality)

  • Medical factors (eg, an existing medical condition or the effects of drugs or medications)

The specific DSM-5 criteria for erectile disorder are as follows [8] :

  • In almost all or all (75-100%) sexual activity, the experience of at least one of the following three3 symptoms: (1) marked difficulty in obtaining an erection during sexual activity, (2) marked difficulty in maintaining an erection until the completion of sexual activity, or (3) marked decrease in erectile rigidity

  • The symptoms above have persisted for approximately 6 months

  • The symptoms above cause significant distress to the individual

  • The dysfunction cannot be better explained by nonsexual mental disorder, a medical condition, the effects of a drug or medication, or severe relationship distress or other significant stressors

The severity of delayed ejaculation is classified as mild, moderate or severe on the basis of the level of distress the patient exhibits over the symptoms. The duration of the dysfunction is specified as follows:

  • Lifelong (present since first sexual experience)

  • Acquired (developing after a period of relative normal sexual functioning)

In addition, the context in which the dysfunction occurs is specified as follows:

  • Generalized (not limited to certain types of stimulation, situations, or partners)

  • Situational (limited to specific types of stimulation, situations, or partners)

Lifelong erectile disorder is associated with psychological factors, whereas acquired erectile disorder is more often related to biologic factors. Distress associated with erectile disorder is lower among older men than among younger men.


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