What should be included in the psychological history for evaluation of erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Factors that give rise to stress factors and tension, whether at work or at home, should be explored. The patient’s psychological state should be assessed, with particular attention to the following:

  • Indications of depression

  • Loss of libido

  • Problems and tension in the sexual relationship

  • Insomnia

  • Lethargy

  • Moodiness

  • Stress from work or other sources

It is especially important to have the patient explain his own interpretation of the problem. To this end, questions such as the following may be asked:

  • Did the onset of ED coincide with a specific event, such as a major operation or a divorce? Have you experienced the death of a spouse or family member?

  • Do you have diminished sexual desire? If so, how long have you had this? Is your diminished sexual desire a primary symptom, or is it a reaction to poor sexual performance?

  • Do you have any feelings of performance anxiety?

Pure psychogenic impotence is relatively uncommon. It is characterized objectively by the presence of good nocturnal and morning erections and negative findings on all other tests. However, a psychogenic component often is present in men with organic ED. A history of highly variable erections that can be totally absent one day but virtually normal the next suggests a psychogenic cause. Virtually 100% of men with severe depression have ED.

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