Volume 5 Issue 4 Apr 2015
Consultation- Liaison Psychiatry Focus: Urology
“The biggest tragedy of all times is the defeat in the bedroom”- Aristotle
The National Institutes of Health (NIH) Consensus Development Conference on Impotence defined
impotence as “male erectile dysfunction, that is, the inability to achieve or maintain an erection sufficient for
satisfactory sexual performance. “Erectile dysfunction (ED) affects more than half of the men above 40 years. In
general, ED is divided into 2 broad categories, organic and psychogenic. However, many men with organic
etiologies may also have an associated psychogenic component. Conditions that may be associated with ED include
diabetes, hypertension, CAD, neurologic disorders, endocrinopathies, benign prostatic hyperplasia, and depression. In
fact, almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems.
In assessing a patient with ED, the first step is to gather the relevant history namely sexual history, medical
and surgical history, medication and nonprescription drug history and psychological history. Various formal questionnaires have been developed to gather objective data regarding ED and to assist clinicians in the evaluation of
their patients including the International Index of Erectile Function (IIEF). The diagnostic workup and evaluation has
to be tailored to each patient. Laboratory testing is necessary for most patients, though not for all. On the basis of
these study results, the physician should be able to determine the medical status of the patient, to identify and
characterize the type of dysfunction, and to determine the need for additional testing (eg, penile or pelvic blood flow
studies, nocturnal penile tumescence testing, or other blood tests). Imaging studies are rarely performed, except in
situations involving pelvic trauma or surgery.
Treatment options include Sex therapy which includes sexual counselling. Medical treatment includes oral
medications, local injection, topical and intra-urethral medication. Principal oral medication include
Phosphodiesterase type 5 (PDE5) inhibitors like Sildenafil. Mechanical treatments include external vacuum devices.
Surgical implants like intra corporeal prosthesis are also available but useful only in irreversible organic damage
refractory to other treatments. Most of the ED has psychological part in it and hence it is best to include the patient’s
partner in treatment after consent of patient.
Consultant Urology and Kidney Transplant., Sir Ganga Ram Hospital New Delhi
