Erectile dysfunction or impotence is a symptom; it is exactly the same as a headache, diarrhoea or chest pain. It is a symptom of other diseases – it is not a diagnosis.
Some fifty years ago it was the universal belief that all impotence was psychogenic or psychological. Now we know that certain patients with certain diseases, i.e. diabetes, high blood pressure, high blood fats in the blood, have impotence that is organic. Patients with these conditions that cause impotence should be treated with Viagra or injections or anything else that works and which the patient finds convenient and acceptable.
The problem we face today is that many patients, certainly if they do not have diabetes, high blood pressure, heart disease to name a few conditions and are under fifty-five years old, almost certainly do not have organic impotence. Any man under fifty-five years without any of these medical conditions, who develops erectile dysfunction, nearly always has impotence of a psychogenic or psychological origin.
The great problem we have is that these patients without a correct diagnosis are being given Viagra, injections or other treatment. This is a deep and terrible mistake because the factors that cause their psychogenic impotence eventually cause these drugs not to work and they then present a very serious problem in management.
Psychogenic impotence must be diagnosed for what it is and the causes and factors clearly delineated, explained to the patient and the patient must receive appropriate psychosexual counselling, behavioural techniques etc. – or both combined, in order to progress forward.
Real problems with the wide availability of drugs like Viagra and now recently Apomorphine is that it is very easy for the patient to get a quick fix to their problem, which will not last. Obtaining an erection is part of the subconscious autonomic nervous system; it is the same as dilating a pupil in poor light and constricting a pupil in bright light. This is a function of the autonomic nervous system and is entirely and totally subconscious and beyond effort of the will. An erection is exactly the same. It is this interference with a natural subconscious reaction to sexual stimuli that causes psychogenic impotence.
The problem is that psychogenic impotence can be very difficult to diagnose and takes a great deal of time. Time is something in very short supply among doctors in general, and the NHS in particular, hence the problem.