Erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time. If this condition is not resolved within a few weeks of beginning the treatment protocol, a firm decision for discontinuation of treatment should be made. In recent years there has been increasing interest in the possible role of potential sexual dysfunction in the pathogenesis of the various sexual disorders. There are a large number of factors which can have a negative influence on sexual function and in any case, treatment must be undertaken with a view to the goal of sexual health. In this regard it should be pointed out that any patient with sexual dysfunction should have strict adherence to treatment, as severe sexual dysfunction may result in serious personal and professional consequences. Symptoms which might indicate an underlying sexual dysfunction include alterations in sleep patterns and reduced libido.
The existence of ED has been documented in patients with a wide range of sexual disorders, including drug- or alcohol-induced disorders of sexual function, dyspareunia, and psychosexual dysfunction such as delayed orgasm, psychogenic ED, and disinhibited sexual behavior. It has also been shown that the presence of psychogenic ED, which can be either painful or otherwise unpleasant and impair sexual desire, can be the hallmark of a sexual dysfunction. During the last years, the psychogenic ED is one of the most frequently discussed sexual problems. A comprehensive view of the etiology of this syndrome shows that there are a number of factors which are responsible for the decrease in sexual desire and in libido that may lead to sexual dysfunction. The sexual dysfunction that might be suspected in the presence of a psychogenic disorder, as well as in those patients presenting with sexual dysfunction following drug or alcohol abuse, is a diagnosis of sexual pain syndrome (SPS) associated with sexual dysfunction. In the patients with SPS, an initial increase in sexual desire occurs after a prolonged period of sexual abstinence, at which point it is found that the dysfunction only manifests itself after ejaculation and that the abnormality is due to decreased blood flow and/or decreased sensitivity to sexual stimuli. If these symptoms are present in their typical intensity and duration, then they cannot be attributed to psychogenic ED.
No impairment of sexual function can be confirmed, nor can a patient receive ed treatment for a psychogenic disorder if the symptoms are still present. Clinical evaluation of psychogenic ED should include a thorough psychiatric history. If a depression is suspected, patients should be assessed for the presence of suicidal ideation. In most cases, antidepressants are contraindicated. In patients with a history of drug abuse, antidepressants have to be applied in a dosage no greater than the dosage in question.
The potential for sexual dysfunction following drug abuse and anabolic steroid abuse is extremely high and this predisposes to the development of sexual dysfunction. Pharmacological therapy includes the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), buspirone, lithium, and the like. The recommendation for treatment of psychogenic ED with SSRIs or TCA and/or bupropion is controversial, and accordingly, the management will be individualized. In recent years, an increase in patients with sexual dysfunction who present with sexual dysfunctions because of AAS abuse has been reported.