DSM-IV

In DSM-IV, this disorder is called Male Erectile Disorder

For more information, see Sexual Dysfunctions

Diagnostic Criteria

A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.

B. The disturbance caused marked distress or interpersonal difficulty.

C. The erectile dysfunction is not better accounted for by another mental disorder (other than a Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:

  • Lifelong Type
  • Acquired Type

Specify type:

  • Generalized Type
  • Situational Type

Specify type:

  • Due to Psychological Factors
  • Due to Combined Factors

Differential Diagnosis

Sexual Dysfunction Due to a General Medical Condition

Male Erectile Disorder must be distinguished from Sexual Dysfunction Due to a General Medical Condition. The appropriate diagnosis would be Sexual Dysfunction Due to a General Medical Condition when the dysfunction is judged to be due exclusively to the physiological effects of a specified general medical condition (e.g., diabetes mellitus, multiple sclerosis, renal failure, peripheral neuropathy, peripheral vascular disease, spinal cord injury, injury of the autonomic nervous system by surgery or radiation). This determination is based on history (e.g., impaired erectile functioning during masturbation), laboratory findings, or physical examination. Noctural penile tumescence studies can demonstrate whether erections occur during sleep and may be helpful in differentiating primary erectile disorder from Male Erectile Disorder Due to a General medical Condition. Penile blood pressure, pulse-wave assessments, or duplex ultrasound studies can indicate vasculogenic loss of erectile functioning. Invasive procedure such as intracorporeal pharmacological testing or angiography can assess the presence of arterial flow problems. Cavernosography can evaluate venous competence. If both Male Erectile Disorder and a general medical condition are present but it is judged that the erectile dysfunction is not due exclusively to the direct physiological effects of the general medical condition, then Male Erectile Disorder, Due to Combined Factors, is diagnosed.

Substance-Induced Sexual Dysfunction

A Substance-Induced Sexual Dysfunction is distinguished from Male Erectile Disorder by the fact that the sexual dysfunction is judged to be due exclusively to the direct physiological effects of a substance (e.g., antihypertensive medication, antidepressant medication, neuroleptic medication, a drug of abuse). If both Male Erectile Disorder and substance use are present but it is judged that the erectile dysfunction is not due exclusively to the direct physiological effects of the substance use, then Male Erectile Disorder, Due to Combined Factors, is diagnosed.

If the arousal problems are judged to be exclusively to the physiological effects of both a general medical condition and substance use, both Sexual Dysfunction Due to a General Medical Condition and Substance-Induced Sexual Dysfunction are diagnosed.

Other mental disorders

Male Erectile Disorder may also occur in association with other Sexual Dysfunctions (e.g., Premature Ejaculation). If so, both should be noted. An additional diagnosis of Male Erectile Disorder is usually not made if the erectile dysfunction is better accounted for by another mental disorder. (e.g., Major Depressive Disorder, Obsessive-Compulsive Disorder). The additional diagnosis may be made when the erectile dysfunction predates the mental disorder or is a focus of independent clinical attention.

Occasional problems with having erections

Occasional problems with having erections that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty are not considered to be Male Erectile Disorder. A diagnosis of Male Erectile Disorder is also not appropriate if the erectile dysfunction is due to sexual stimulation that is not adequate in focus, intensity, and duration. Older males may require more stimulation or take longer to achieve a full erection. These physiological changes should not be considered to be Male Erectile Disorder.

DSM-5

Diagnostic Criteria

A. At least one of the three following symptoms must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

  1. Marked difficulty in obtaining an erection during sexual activity.
  2. Marked difficulty in maintaining an erection until the completion of sexual activity.
  3. Marked decrease in erectile rigidity.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:

  • Lifelong: The disturbance has been present since the individual became sexually active.
  • Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:

  • Generalized: Not limited to certain types of stimulation, situations, or partners.
  • Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:

  • Mild: Evidence of mild distress over the symptoms in Criterion A.
  • Moderate: Evidence of moderate distress over the symptoms in Criterion A.
  • Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

Differential Diagnosis

Nonsexual mental disorders

Major depressive disorder and erectile disorder are closely associated, and erectile disorder accompanying severe depressive disorder may occur.

Normal erectile function

The differential should include consideration of normal erectile function in men with excessive expectations.

Substance/medication use

Another major differential diagnosis is whether the erectile problem is secondary to substance/medication use. An onset that coincides with the beginning of substance/medication use and that dissipates with discontinuation of the substance/medication or dose reduction is suggestive of a substance/medication-induced sexual dysfunction.

Another medical condition

The most difficult aspect of the differential diagnosis of erectile disorder is ruling out erectile problems that are fully explained by medical factors. Such cases would not receive a diagnosis of a mental disorder. The distinction between erectile disorder as a mental disorder and erectile dysfunction as the result of another medical condition is usually unclear, and many cases will have complex, interactive biological and psychiatric etiologies. If the individual is older than 40-50 years and/or has concomitant medical problems, the differential diagnosis should include known medical etiologies, especially vascular disease. The presence of an organic disease known to cause erectile problems does not confirm a casual relationship. For example, a man with diabetes mellitus can develop erectile disorder in response to psychological stress. In general, erectile dysfunction due to organic factors is generalized and gradual in onset. An exception would be erectile problems after traumatic injury to the nervous innervation of the genital organs (e.g., spinal cord injury). Erectile problems that are situational and inconsistent and that have an acute onset after a stressful life event are most often due to psychological events. An age of less than 40 years is also suggestive of a psychological etiology to the difficulty.

Other sexual dysfunctions

Erectile disorder may coexist with premature (early) ejaculation and male hypoactive sexual desire disorder.

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