Issues in the psychiatric diagnosis and management of impotence

The evaluation and management of impotence has received increasing attention in recent years, largely because of the development of new techniques of diagnosis and treatment discussed in the present review. The author reviews the role of psychiatry in (a) understanding psychogenic impotence, (b) differentiation of psychogenic from organic impotence and (c) developing the rationale and methods of the newer treatment modalities. The impact of the availability of surgical penile prosthesis implantation on the role of psychiatry in evaluating impotent subjects is discussed. The author indicates that much remains to be learned about the indications for surgical versus psychological treatment of impotence, and about the effectiveness of psychological interventions.