Contextual approaches to the physiology and classification of erectile function, erectile dysfunction, and sexual...

This paper offers a reexamination of some long-held beliefs relating to the physiology of erectile function and dysfunction, including the idea that there is a singular physiology of erection. Rather, there appear to be plural neural, neurochemical, and endocrine mechanisms whose participation in erectile function depends on the behavioral context in which erection occurs. The best examples of this context-dependent physiology come from research on rats. For example, the medial amygdala is essential for noncontact erection in response to inaccessible estrous females, but not for erection during copulation. Also, androgen is necessary for touch-based and noncontact erection, but not for erection during copulation. Even the specific dopamine receptors important to erection may differ, depending on the context. If there is not a singular physiology of erection, then it follows that the physiology of erectile dysfunction may also vary from context to context. Thus, some disorders of the central nervous system may not be manifested in sleep-related erection, and therefore may be misinterpreted as "psychogenic" erectile dysfunction. This term belies the axiom that all psychological processes have a somatic basis; therefore, there can be no psychogenic dysfunction that does not involve organic processes which may respond to pharmacotherapy. A revised classification of erectile dysfunction based on this premise is offered. Finally, closer attention to erectile context may also illuminate male "sexual arousal" and its relation to "sexual motivation". The former term has so many meanings in current usage as to impede research, especially into the physiology of sexual arousal, which depends on comparisons between animals and humans. It is proposed that attention be given to two variables: whether or not erection occurs and whether or not the context is sexual. The occurrence of penile erection within a sexual context is viewed as the only case in which sexual arousal may be inferred unambiguously.