Psychological perspectives on male erectile dysfunction: a reappraisal

With accumulating, strongly supportive epidemiological evidence, a new understanding has emerged of the complex interactions between psychological factors (e.g., depression) and both erectile dysfunction (ED) and ischemic heart disease (IHD) in men.

To elucidate the relationship between depression, ED, and IHD.

We review recent studies on the relationship between ED, depression, and IHD. We also describe and evaluate current psychological theories related to ED onset and maintenance and consider the implications of recent large-scale studies linking ED, whether organically or psychologically based, with the presence of common, chronic diseases in men, particular IHD and depression.

There is a well-documented association between depression and both the development of IHD. Longitudinal studies have shown that the presence of depression increases the incidence and risk of ED over time; conversely, successful treatment of ED has been associated with significant improvements in mood and depression scores in patients with concomitant ED and depression. Treated depression has also been shown to reduce the risk of incident IHD. The recent Princeton IV panel concluded that ED is a potential harbinger or moderator of the link between depression and IHD. Additionally, the panel concluded that there is sufficient evidence currently to support the observation that psychogenic ED is an independent risk factor for heart disease in men. These findings apply in younger and older men.

The studies reviewed strongly suggest the need for more collaboration between mental health and other health care practitioners. Combination therapy has repeatedly been shown to increase treatment satisfaction and compliance, sexual and relational satisfaction, and decrease discontinuation rates. Finally, we discuss the next set of challenges in mental health including the role of AI sex- or psychotherapy.