EpistemisPsychogenic sexual dysfunction
Specialty: Psychiatry.
Why it occurs
- Depressive or anxiety disorders (most common psychiatric cause)
- Chronic stress or couple dysfunction
- History of trauma or childhood sexual abuse
- Execution anxiety (very common in erectile dysfunction or premature ejaculation)
- Side effects of psychotropic drugs (especially SSRIs and antipsychotics that elevate prolactin)
Initial workup
Determination of serum prolactin, free and total testosterone, estradiol, TSH, lipid profile and glycemia (to rule out endocrine or organic causes such as diabetes mellitus or dyslipidemia); Doppler ultrasound of penile vessels if a vascular cause is suspected; IIEF questionnaire (International Index of Erectile Function).
red flags
Association with symptoms of severe major depression, deep hopelessness or ideation of self-lysis as a consequence of the impact of the dysfunction on the patient's relational life and self-esteem.
Standard management
- Sildenafil or Tadalafil — PDE-5 inhibitors, useful in erectile dysfunction, including psychogenic ones, by breaking the vicious cycle of performance anxiety
- Bupropion — alternative antidepressant that does not cause sexual dysfunction and can act as a pro-sexual
- Mirtazapine — antidepressant with less sexual impact than SSRIs
- Cabergoline (dopamine agonist if hyperprolactinemia secondary to antipsychotics is noted).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 5
- Treatment options
- 4