Classification of Erectile Dysfunction: organic versus psychological

Erectile dysfunction(ED) is the consistent inability to maintain an erection with enough rigidity to allow sexual intercourse. Incidence is age-related. ED is classified as organic or functional(psychological). With the latter, the patient has normal nocturnal and morning erections and can have normal erections with masturbation. With the organic cause, there are 2 different manifestations: loss of libido and loss of erections. Patients often present either of the two manifestation or both. A loss of libido may indicate androgen deficiency from either hypothalamic, pituitary, or testicular disease. The site may be localized with serum testosterone and gonadotropin levels. Loss of erections, however, is often a result of arterial, venous, neurogenic, or psychogenic problems. If morning erections occur, an organic cause is unlikely. The history also must search for other medical conditions and medications that the patient may be taking. Centrally acting sympatholytics (e.g., methyldopa) can cause ED, use of beta-blockers and spironolactone can result in loss of libido.