Psychogenic ED?

[Flavio]

I'm not an expert but I have a theory about psychogenic impotence: there is no psychogenic impotence.

Before Viagra, all cases of ED were considered to be purely psychological. It's all in the head. Men were indiscriminately sent to sex therapy, where they probably spent a fortune and had no visible results. The advent of PDE-5 inhibitors changed all that and we now know that ED is often associated with other medical conditions - e.g. diabetes or high blood pressure.

Only a minority of cases is now considered to be 'psychological' but I believe that as medical science in the field of ED progresses, this category will simply disappear.

It doesn't make much sense to differentiate between psychogenic/organic ED. The so-called psychogenic impotence has a very physical, obvious consequence: loss of erection. And maybe all forms of ED have physical causes. Maybe what we now call sexual performance anxiety has in fact a physical origin: an over active sympathetic system or a malfunctioning amygdala. The problem is we still know very little about the human brain and the central nervous system.

If the problem lies in the brain, we need medical treatments that act directly on the brain. This is why I believe centrally acting drugs are the future of ED treatment. Apomorphine was one of them. Unfortunately, the FDA didn't approve apomorphine for the treatment of ED in the US and it was poorly marketed in Europe and eventually disappeared. This is terribly frustrating.

Rexahn's ZORAXEL is another dopaminergic agent that shows great promise and those guys at Rexahn Pharmaceuticals seem to really know what they're doing (e.g. they're not marketing ZORAXEL as a direct Viagra competitor, but as a whole new ED treatment). I have great faith in this new treatment, let's just hope the FDA doesn't screw things up (again!). Meanwhile, all we can do is wait - and maybe buy some Rexahn shares

[arod3]

My issue is similar. I get so much fear about not be able to get it up. I live in a small town and everyone knows each other especially the girls. Last time I slept with a chick from a local bar I could not get it up. The next wee all my friends knew about it and I had to lie and deny!!! It is not funny and I am sure I suffer from psychological impotence, I have no problems masturbating. Never tried viagra but am considering

[Willie]

Go see a urologist dude. For the longest time I just told myself it was psychological when it wasn't. If it is a physical problem, at least you'll be better prepared and can get your hands on some drugs like Viagra.

[Flavio]

Willie is right: you should go see a urologist just to make sure there's nothing phisically wrong with you.

If your case is purely psychological, I believe Rexahn's Zoraxel may be the perfect solution. It is a centrally acting ED drug with anxiolytic proprerties (i.e. it makes you calmer and hornier ) that works by raising dopamine and serotonine levels in the brain.

Zoraxel is going to be available in 2013 and it is the first drug to improve erections, libido and orgasm. The problem is most men suffering from psychogenic ED or sexual performance anxiety don't even considere they have a medical condition and don't search for help. I believe this may have been one of the reasons for Uprima's (another dopaminergic agent) commercial failure.

[arod3]

Yeah good point. Think I am going to see him this week. It happened again yesterday and I felt like a jackass. I think it is just my stupid nerves telling me "YOU CAN'T DO IT"

[Willie]

Here is what my urologist originally talked to me about: spontaneity. If you can get a rapidly developing erection when looking at porno, then the problem is in your head.

I could always get an erection with porno, but it was "slow to fill" as my urologist said. He then did some tests on me to prove my arteries don't produce the blood pressure they should.

Are your erections when alone slow to fill? If so, you may have a physical problem.

[aaron]

Yep same here, I have no issues watching god old porn and get get really hard by doing this but I do need meds with a real girl, I know mine is in my head

[Flavio]

Yep same here, I have no issues watching god old porn and get get really hard by doing this but I do need meds with a real girl, I know mine is in my head

Yes, it may be purely psychological but you should still see a urologist, like Willie said. Even if it's 'just in the head', your urologist is the most qualified person to help you.

Like I said on my first post, the so-called 'psychogenic' ED is a health problem and there are solutions available.

ED drugs were very helpful in my case: CIALIS and VIGAMED. And I may have found a third solution this week: valerian pills. Valerian is a totally natural product and has none of the inconveniences of chemical anxiolytics (e.g. no sexual side effects), so it could be a great solution for theses cases of sexual performance anxiety. I'll post something about it soon.

[Flavio]

Still on the subject of psychogenic ED, here's an interesting study on ED in patients with combat-related post-traumatic stress disorder:

http://www.urotoday.com/index.php?op..._ua&id=2222839

Apparently, Viagra didn't work. This shows, once again, that PDE-5 inhibitors are not the best solution in these cases and psychogenic ED is still an unmet medical need. Zoraxel and other centrally acting drugs will be more than welcome when they hit the market.

[Flavio]

Some interesting views on the subject of psychogenic Ed that confirm my original post:

"In some situations, such as in cases where performance-related anxiety is prominent, it seems that there may be overactivity of the sympathetic nervous system which leads to increased caversonal smooth muscle tone and a subsequent tendency to maintain penile flaccidity."

"The recognition that organic factors are important in the pathogenesis of ED arose in the 1970s and 1980s. Prior to that there had been a belief that the majority of cases had a psychogenic origin. It is tempting to categorise men with ED into those with 'psychogenic' and those with 'organic' ED, but in reality this is probably an overly simplistic distinction."

"It is clear that organic and psychogenic dysfunction can co-exist and, furthermore, that they are not inversely related. Accordingly, just because a man has significant organic disease contributing to his ED, it does not mean that there are no co-existing psychological factors which are also important, and current thinking suggests that the most important of these is performance-related anxiety."


(ED: Current Investigation and Management, Ian Eardley & Krishna Sethia)