According to many experts, the psychogenic component is present in all cases of erectile disorder. DSM 5 (The Diagnostic and Statistical Manual of Mental Disorders, fifth edition) has defined new specifications for the evaluation of potency violation in men.
Many men, who suffer from erectile dysfunction, experience a decrease in sexual interest, anxiety, nervousness, pessimism, irritability, fear, anxiety and nervous tension.
All these symptoms can progress and significantly worsen the mental state of a man.
According to the DSM 5, an erectile disorder is diagnosed in those men, who experience stress and discomfort for at least half a year because of the inability to achieve an erection.
Erectile dysfunction can be diagnosed only if the problems with erection are not caused by the use of any medication.
One of the main DSM 5 criteria that allows to diagnose ED is the loss of penis rigidity and the inability to maintain an erection for a successful completion of a sexual intercourse.
Men at-risk are those who have office work: sedentary lifestyle causes emotional lability and imbalance, weakening of adaptive mechanisms against stress and the development of the erection problems.
The DSM 5 manual determines that erectile disorder is very often associated with major depression. During the evaluation, the following 5 factors should be considered (if they may be relevant to etiology and/or treatment):
- treatment courses undergone, use of drugs as therapy ;
- general state of health of the sexual partner;
- sexual relationship (different wishes and desires for sexual activity between the partners);
- confession or cultural issues (attitudes towards sex, taboos for sexual behavior manifestations);
- the state of man’s emotions (unattractive figure, stressful job, existing psychiatric comorbidity, experienced sexual or emotional abuse);
Each of these factors has its certain impact on the presenting of symptoms in different men with this disorder.
Stages of erectile disorder diagnosis, established by the DSM 5, include the collection of symptoms, evaluation of potency problems by dynamic infusion cavernosometry, penile doppler ultrasound.
Depending on the clinical picture, age and health condition, men who report decreased sexual activity, can test their free testosterone and serum bioavailable.
It may also be necessary to go through the assessment test for thyroid function and determine the glucose blood level (to exclude the presence of diabetes mellitus).
As explained in the DSM 5, erectile disorder, which is fully explained by medical factors, is the most difficult aspect of the differential diagnosis for this disease. Such cases would not receive a diagnosis of a mental disorder.
Differences between the erectile dysfunction that is caused by another medical condition and the erectile dysfunction as a mental disorder are not always clear. Many of these cases have a common psychiatric and biological etiology.
If the patient is older than 40-50 years and/or has related health problems, the differential diagnosis for potency problems should include medical etiologies (first of all, cardiovascular diseases).
As stated in the DSM 5, erectile disorder caused by psychological distress can manifest suddenly and occur sporadically. Night and morning spontaneous erections are present, yet a weak erection may totally disappear immediately before an intercourse.
Causes of dysfunction in such cases reduce to individual feelings, emotions and experiences of men. The leading treatment method for these conditions is psychotherapy, because the basis of these disorders are anxiety and phobic disorders.
At the same time, the use of phosphodiesterase inhibitors type 5 (PDE5) allows accelerating the beginning of an intimate relationship, so they are often used during the psychotherapeutic interventions.
According to experts, PDE5 inhibitors are the first line treatment drugs of psychogenic and organic erectile dysfunction.
They not only help to prevent subsequent violations, but also initiate psychological rehabilitation in cases where these dominate.
Doctors also use sometimes psychotherapy, as well as the antianxiety, antiasthenic and antidepressant agents in expressed depressive, neurotic and asthenic conditions.
While following the recommendation and diagnostic criteria for erectile disorders, proposed in the DSM 5, doctor can assign the appropriate treatment protocol and prevent further progression of the process.