Psychological factors involved in impotence. A review of the literature

Intracavernous papaverine in the management of psychogenic impotence

Intracavernous papaverine has found an important place in the management of male erectile failure. The effect of this mode of therapy was studied in 48 patients with psychogenic impotence. The average follow-up for this group of patients ranged from 7 months to 37 months (mean 16.3 months). All the patients in this group were advised sex therapy as an initial mode of therapy. On refusal to undergo sex therapy, they were offered an option of intracavernous papaverine injection. Papaverine appears to break the performance anxiety erectile failure cycle and was noted to have good results. Overall 57.9% patients expressed complete satisfaction with this mode of therapy. One patient (2.1%) developed priapism, which was adequately treated with intracavernous epinephrine. Use of low dosage of papaverine is suggested as an additional mode of therapy in the management of psychogenic impotence.

Short REM latency in impotence without depression

In a retrospective study, the presence of depression was studied in a group of 14 impotent patients who were selected on the basis of the similarity between their electroencephalographic (EEG) sleep patterns and those of patients with endogenous depression. Specifically, the value of rapid eye movement (REM) latency plus age less than 100 was used as a selection criterion. Sleep continuity disturbances, increased REM time, and increased REM% were noted in the short REM latency impotent group. On the basis of MMPI and psychiatric history and interview, only one of these impotent patients showed major depression. The authors conclude that impotent patients with a short REM latency are not, as a group, depressed and that the incidence of depression in impotent men should be determined irrespective of EEG sleep findings.