Organic erectile dysfunction or impotence of organic origin is defined as the inability to achieve an erection that is sufficient to penetrate the vagina, or as the inability to maintain an erection until the completion of sexual intercourse.
Unlike psychogenic impotence, which can be caused by stress, depression, sexual trauma, a conflict situation in a relationship, etc., organic erectile dysfunction is associated exclusively with problems of physical condition.
Differences between organic and psychogenic ED
Patients with organic ED describe erection problems that progress from months to several years. At first, these are incomplete erections or hard erections that become sluggish during sexual intercourse. Over time, complete or total erectile insufficiency occurs. Organic impotence is characterized by constancy, it does not get better or worse depending on the change of partner, as well as with any types of stimulation.
Psychogenic ED is usually sudden, often caused by psychological trauma, it can increase and vice versa. Patients with psychogenic impotence may have complete erectile insufficiency with one partner, but not with another, experience sexual failure during sexual intercourse, but get a persistent erection during mastrubation. Normal spontaneous erections in the morning suggest psychogenic causes of impotence rather than organic ones.
Differential diagnosis of psychogenic and organic erectile dysfunction
|Characteristics||Organic ED||Psychogenic ED|
|Age||> 50 years||< 50 years|
|Time interval||< 1 year||> 1 year|
|Psychosexual problems||Secondary||Long history|
|Problems in relationships||Secondary||At the initial stage|
|Anxiety and fear||Secondary||Primary|
Causes of organic erectile dysfunction
The circulatory system plays a central role in obtaining and maintaining an erection, so the examination of the vascular system is an important stage in assessing the condition of a patient with ED. Vascular lesions — usually atherosclerotic, but sometimes fibrous, systemic hypotension restrict blood flow in the body. In some patients, the blood flow may be sufficient to achieve an erection, but insufficient to maintain it during sexual intercourse.
In patients with ED, some endocrine disorders are also detected, in particular, hypogonadism. As a rule, impotence due to hypogonadism is partial and is accompanied by a decrease in libido. In addition, hypothalamic-pituitary disorders, including tumors, are the most common endocrine disorders that cause impotence. Some medications, including alcohol, can lead to impotence as a result of endocrine disorders.
The medical history may indicate one of several mechanical causes of ED, for example, Peyronie’s disease, as well as congenital or acquired penile abnormalities. When palpating the penis, the doctor can diagnose the presence of plaques in the cavernous bodies, which may indicate Peyronie’s disease.
If the patient is supposed to have organic ED, studying the medical history, physical examination and laboratory diagnostics will help determine its cause. Vascular diseases are the most common cause of organic impotence.