Erectile Disorder DSM-5 302.72 (F52.21)
DSM-5 Category: Sexual Dysfunctions
Introduction
According to the DSM-5, Erectile Disorder is characterized by a recurrent inability to achieve or maintain an adequate erection during partnered sexual activities (American Psychiatric Association, 2013). It may occur in 7% - 18% of the male population at some point throughout their lifetime. Erectile Disorder is one of a number of conditions categorized under the broader heading of Sexual Dysfunctions - a more comprehensive grouping in scope that includes sexual problems experienced by men and women.
The DSM-5 defines Erectile Disorder by stating what symptoms must not be present as well as what should be. For example, it is not considered male erectile disorder if it is merely an occasional problem or if it does not create distress and interpersonal difficulty. Specific to this disorder as well; the problem cannot be more appropriately traced to a different disorder other than to say it is a sexual dysfunction; and it is not caused exclusively by a physiological factor such as substance abuse or other medical condition (Khera & Goldstein, 2011).
The authors of the DSM -5 ultimately recommended that erectile disorder be precisely defined in order to clearly differentiate it from normal functions and a condition requiring medical intervention. These changes were also intended to facilitate clinical research.
Symptoms of Erectile Disorder
The DSM-5 states that a diagnosis of Male Erectile Disorder will manifest at least one of three symptoms 75% to 100% of the time during sexual activity (American Psychiatric Association, 2013). Men will struggle to achieve an erection during sexual activity; or men will struggle maintaining an erection until the completion of sexual activity; or there will be a noticeable decrease in erectile rigidity. The diagnosis requires persistence of these symptoms for approximately six months. Other factors that must be taken into consideration include whether the condition is generalized or situational; and if it is a mild, moderate or severe case (Warren, 2009).
Male Erectile Disorder is a condition among several that are classified under the category of Sexual Dysfunction. It is most common in men over 50 years of age. A diagnosis of Erectile Disorder will often occur through a process of elimination that discounts the presentation of other possible pathologies.
Daily Life
Men are especially affected by an interruption to their sexual performance or an inability to perform sexually. It is usually emotionally devastating. Therefore, if men experience multiple instances in which they are not able to obtain or maintain an erection they should seek medical support. A thorough physical examination will uncover a pathological source if one exists. Any possibility of lifestyle habits that could impede a man’s ability to get and maintain an erection will be considered. The attending doctor will probably recommend avoidance of tobacco and/or alcohol and a change of other behaviors that could affect male sexuality.
It will be important for the man to have support in changing lifestyle behaviors. In fact, couple and/or family lifestyle changes can create a healthier perspective and routine that will benefit everyone. It really may be as simple as eating more nutritiously; and getting an adequate amount of exercise and sleep. Certainly, lifestyle changes such as these cannot be harmful to the male who is experiencing erectile disorder as defined by the DSM-5 (McMahon, 2014).
Too, absent a biological cause for the dysfunction, psychotherapy will be recommended. Here changes in lifestyle will probably be suggested as well. Couples counseling may be proposed; and the support of the partner could create a healthier and more satisfying sexual life for both people.
Treatment of Erectile Disorder
The DSM-5 does not specify treatment options for Erectile Disorder; but both psychotherapeutic and pharmacological treatment approaches have increased markedly in the last two decades. One regimen that has grown in use is the Cognitive-Interpersonal treatment of Male Erectile Disorder. This five-part model incorporates psycho-educational and cognitive intervention; sexual and performance anxiety reduction; script assessment and modification; conflict resolution and relationship enhancement; and relapse prevention training. The program has several applications that address the disorder from a variety of positions. AT the same time, the interventions approach the disorder on multiple levels; increasing the possibility that the outcome will be satisfactory, comprehensive and offer the patient a greater level of assurance that the disorder will not return.
Psychotherapy may be recommended to determine if the erectile disorder is caused by depression or anxiety. Often there is evidence of comorbidity of a mood disorder; which may best be addressed pharmacologically and through further talk therapies. Seeking individual and/or partner counseling with a professional, trained and experienced sex therapist – where one is able to discuss issues with a partner in a safe, nonjudgmental environment that will provide a variety of alternative solutions – is an excellent recommendation as well.
It is important to remember that Erectile Disorder affects both partners in a relationship; and communication is imperative. Sex therapy has proven to be an effective treatment for Erectile Disorder (McMahon, 2014). This treatment consists of five to twenty sessions with a sex therapist; usually one hour a week. A sex therapist may require the couple to participate in a number of exercises at home including touching, reading books about sexuality and improving communication skills during sex. Sex therapy has been found to be particularly helpful when Erectile Disorder is caused by stress and anxiety.
Sometimes the condition may subside with the introduction of lifestyle changes that minimize the multiple psychological interferences men experience regarding their sexual performance. This may include a wide variety of changes such as limiting or avoiding the use of tobacco and/or alcohol.
Medication has also become an increasingly acceptable alternative; with a large number of pharmacological choices designed to help men obtain and maintain an erection. Common prescription drugs are Viagra, Cialis, and Levitra. Persons who opt for medication to support their sexual abilities should undergo a complete physical examination and an assessment of current medications to confirm there will be no negative outcomes of drug interaction. At the same time, men with erectile disorder may actually be experiencing problems due to a medication that has been prescribed for a separate condition. Again, professional review and intervention is essential to pinpoint the cause according to the symptoms iterated in the DSM-5 and assign the appropriate treatment protocol.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Carr, A. (2014). The evidence base for couple therapy, family therapy and systemic interventions for adult‐focused problems. Journal of Family Therapy, Vol. 36, Iss. 2, pp. 158 – 194.
Khera, M. & Goldstein, I. (2011). Erectile dysfunction. Clinical Evidence, Vol. 2011.
McMahon, C. (2014). Erectile dysfunction. Internal Medicine Journal, Vol, 44, Iss. 1, pp. 18 – 26.
Warren, E. (2009). Erectile dysfunction. Practice Nurse, Vol. 38, Iss. 8, p. 19.
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