Visual erotic stimulation test for initial screening of psychogenic erectile dysfunction: a reliable noninvasive alternative?

We determined the role and validity of visual erotic stimulation using RigiScan monitoring as a more physiological and cost-effective diagnostic modality for primary noninvasive screening of psychogenic versus organic impotence. We also clarified the correlation between erotic and pharmacological erections, and their diagnostic usefulness in the clinical routine.

A total of 76 impotent patients and 20 potent controls were entered into the study. A detailed medical and sexual history was obtained, and psychological evaluation and minimally invasive diagnostic studies were done, including a 15-minute visual erotic stimulation test, intracavernous pharmacological stimulation with 10 micrograms. prostaglandin E1 and penile duplex ultrasound. Responses to each test were interpreted blindly and independently of each other, and of the results of the psychological evaluation. Visual erotic stimulation results were then correlated with the results of intracavernous pharmacological stimulation and penile duplex ultrasound, and validity assessments were also obtained.

Results of the visual erotic stimulation test confirmed the clinical diagnosis in 10 of the 14 patients (71%) with psychogenic impotence (71% sensitivity and 96% specificity). There was a 97% correlation with the clinical diagnosis of predominantly organic dysfunction (97% sensitivity and 71% specificity). However, characterization of the etiological inferences based on visual erotic stimulation findings was poor.

A positive response to visual erotic stimulation is strongly indicative of a predominantly psychogenic cause of erectile dysfunction. In combination with patient sexual history and pharmacological erection testing, visual erotic stimulation can be performed as an initial, minimally invasive test for cost-effective screening of psychogenic impotence.