[Psychological stress factors in erectile dysfunctions. Causal models and empirical results]

In this paper the role of psychosocial factors in erectile dysfunction is examined in two different ways: (1) Current approaches to the causation of psychogenic erectile dysfunctions are reviewed and discussed. (2) Empirical results from a large unselected sample of sexually dysfunctional men are presented and compared to a sample of functional men. Concerning etiological models the traditional unidimensional dichotomous concepts (psychogenic versus organic) of erectile dysfunction have to be abandoned and replaced by two-dimensional models that are able to take the clinical reality into account that many patients have both significant psychological and organic factors in their disorder. The main causes of psychogenic erectile disorders can be divided into three groups, each belonging to a different phase of time: (i) immediate factors (performance anxiety), (ii) antecedent life events from recent history, (iii) developmental vulnerabilities from childhood and adolescence. The specific interplay as well as the importance of the different groups is different in primary and secondary erectile disorders. The empirical results presented here are based on a sample of 751 patients from our interdisciplinary outpatient unit for sexually dysfunctional men and a group of 55 sexually functional men. Both groups completed a self-developed, multidimensional questionnaire addressing a variety of psychosocial and descriptive factors concerning erectile disorders. The results prove the heterogeneity of patients and their respective erectile problems and show a number of highly significant group differences. The frequent comorbidity of erectile disorders and premature ejaculation and disorders of desire is worth mentioning as well as the high prevalence of depression and the extreme extent of performance anxiety in the patient group. The results are discussed with respect to future treatment strategies. The necessity of combined psychosomatic approaches optimizing the efficacy of all available therapeutic options is particularly stressed.