Assessment of sexual function, interest and activity in depressed men

The association of hypogonadism with depression and its treatments

According to World Health Organization estimates, 5% of the adult population worldwide suffers from depression. In addition to the affective, psychomotor and cognitive symptoms which characterize this mood disorder, sexual dysfunction has been frequently reported among men suffering from depression. The most common sexual manifestations are decreased libido, erectile dysfunction and orgasmic disorder. In addition, epidemiological studies have documented a reduction of testosterone concentrations in men with depression and, for these reasons, depressive disorders appear as one possible cause of male functional hypogonadism. Moreover, some largely used antidepressant medications can cause or worsen sexual complaints, thus depression and its treatments rise several andrological-relevant issues. The other way round, men with hypogonadism can manifest depressed mood, anxiety, insomnia, memory impairment which, if mild, may respond to testosterone replacement therapy (TRT). However, the prevalence of functional hypogonadism in depression, and of depressive symptoms in hypogonadal men, is not known. Severe depressive symptoms do not respond to TRT, while the effect of treating major depression on functional hypogonadism, has not been investigated. Overall, the clinical relevance of each condition to the other, as well as the physiopathological underpinnings of their relationship, are still to be clarified. The present review summarizes current evidence on the influence of testosterone on mood and of depression on the hypothalamic-pituitary-testis axis; the clinical association between male hypogonadism and depression; and the reciprocal effects of respective treatments.

Sexual anxiety and sexual beliefs as mediators of the association between attachment orientation with sexual functioning and distress in university men and women

Previous research has demonstrated the association between sexual functioning and attachment orientation in women. However, the mechanisms of this relation are not yet well understood, and this effect has not been substantially investigated in men. The current study examines the role of sexual anxiety and dysfunctional beliefs about sexuality as mediators of the correlation of attachment orientation with sexual functioning and distress in both women and men. A university sample of men (n=307) and women (n=716) completed questionnaires assessing attachment orientation, sexual functioning, sexual distress, sexual anxiety, and dysfunctional sexual beliefs. Multiple regression analyses indicated that insecure attachment orientation significantly predicted poorer sexual functioning and higher sexual distress in both men and women. Path analyses showed partial mediation of these effects by sexual anxiety and dysfunctional sexual beliefs. Gender differences existed in the specific pattern of associations between the variables. These results suggest that attachment difficulties may facilitate the development of sexual difficulties through an increased vulnerability to maladaptive cognitions and negative affect (specifically anxiety) regarding sexuality.

Sexual Functioning in Young Women and Men: Role of Attachment Orientation

Prior research has documented various ways in which adult attachment styles are characteristic of differential behavioral and cognitive patterns within romantic relationships and sexuality. However, few studies have examined the direct influence of anxious or avoidant attachment orientation on sexual function. The aim of the present study was to assess the impact of insecure attachment on sexual function. Undergraduate students completed questionnaires measuring attachment style and sexual functioning. Among women, attachment avoidance tended to be associated with impairments in all aspects of sexual function, whereas anxious attachment tended to be associated with declines in arousal, satisfaction, and ability to achieve orgasm. A different trend was seen in men: Anxious attachment tended to be associated with multiple facets of sexual dysfunction, while avoidant attachment did not correlate with any sexual function deficits and was associated with superior physiological competence. These results suggest that both anxious and avoidant attachment styles are important yet differential predictors of sexual function in men and women.

A systematic review of sexual dysfunction measures for gay men: how do current measures measure up?

The measurement of subjective components of sexual functioning is of increasing importance in clinical research and practice. Differences have been reported in prevalence rates and experiences of sexual difficulties between heterosexual and gay men. The aim of this article is to identify reliable and valid measures of sexual dysfunction suitable for use with gay men. Seven measures were reviewed; details about item development, dimensionality, reliability, and validity are provided. Heteronormative and heterosexist wording were evident throughout. Several areas of concern emerged in relation to psychometric properties (e.g., questionable validity). No psychometrically robust sexual function measure was identified for use with gay populations.

Effects of antidepressant treatment on sexual arousal in depressed women: a preliminary FMRI study

OBJECTIVE

There was a recent study to explore the cerebral regions associated with sexual arousal in depressed women using functional magnetic resonance imaging (fMRI). The purpose of this neuroimaging study was to investigate the effects of antidepressant treatment on sexual arousal in depressed women.

METHODS

SEVEN DEPRESSED WOMEN WITH SEXUAL AROUSAL DYSFUNCTION (MEAN AGE: 41.7±13.8, mean scores of the Beck Depression Inventory (BDI) and the 17-item Hamilton Rating Scale for Depression (HAMD-17): 35.6±7.1 and 34.9±3.1, respectively) and nine healthy women (mean age: 40.3±11.6) underwent fMRI before and after antidepressant treatment. The fMRI paradigm contrasted a 1 minute rest period viewing non-erotic film with 4 minutes of sexual stimulation viewing an erotic video film. Data were analyzed by SPM 2. The relative number of pixels activated in each period was used as an index of activation. All depressed women were treated with mirtazapine (mean dosage: 37.5 mg/day) for 8 to 10 weeks.

RESULTS

Levels of brain activity during sexual arousal in depressed women significantly increased with antidepressant treatment (p<0.05) in the regions of the hypothalamus (3.0% to 11.2%), septal area (8.6% to 27.8%) and parahippocampal gyrus (5.8% to 14.6%). Self-reported sexual arousal during visual sexual stimulation also significantly increased post-treatment, and severity of depressive symptoms improved, as measured by the BDI and HAMD-17 (p<0.05).

CONCLUSION

These results show that sexual arousal dysfunction of depressed women may improve after treatment of depression, and that this improvement is associated with increased activation of the hypothalamus, septal area, and parahippocampal gyrus during sexual arousal.

Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension

Sexual dysfunction is often implicated in depression and anxiety disorders, but the current nosology of sexual dysfunction, depression, and anxiety (i.e., DSM-IV) does not adequately address these relationships. Because recent papers (Krueger, R. F., & Markon, K. E. (2006). Reinterpreting comorbidity: A model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology, 2, 111-133) have suggested and provided evidence for latent internalizing and externalizing dimensions that help explain high comorbidity between mental disorders, the current paper suggests that sexual dysfunction might conceptually belong to a latent internalizing factor. To address this, evidence is presented for the relationship among disorders of sexual desire, arousal, and orgasm comorbid with depression and anxiety. A review of sexual disorders is also presented along with a critical examination of the way the current DSM is organized with respect to sexual dysfunction, depression, and anxiety.

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al., 1994) and the Indiana Mental Health Services and HIV Risk Study (Wright, 2003). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HIV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.

Gender differences in the content of cognitive distraction during sex

This study compared 220 college men and 237 college women on two types of self-reported cognitive distraction during sex, performance- and appearance-based. Affect, psychological distress, sexual knowledge, attitudes, fantasies, experiences, body image, satisfaction, and sexual function were assessed with the Derogatis Sexual Functioning Inventory and the Sexual History Form to determine associations with distraction. Between-gender analyses revealed that women reported higher levels of overall and appearance-based distraction than did men, but similar levels of performance-based distraction. Within-gender analyses revealed that women reported as much of one type of distraction as the other, while men reported more performance- than appearance-based distraction. In women, appearance-based distraction was predicted by negative body image, psychological distress, and not being in a relationship, while performance-based distraction was predicted by negative body image, psychological distress, and sexual dissatisfaction. In men, appearance-based distraction was predicted by negative body image, sexual dissatisfaction and not being in a relationship, while performance-based distraction was predicted by negative body image and sexual dissatisfaction. Investigating the content of cognitive distraction may be useful in understanding gender differences in sexual experience and in refining cognitive components of sex therapy.

Sexual dysfunction in female patients with panic disorder alone or with accompanying depression

Objective. The aim of this study was to evaluate sexual dysfunction in female patients with panic disorder and to investigate the impact of accompanying depression with regard to sexual dysfunction. Method. Twelve patients who met the diagnostic criteria for panic disorder without depression (P) and 28 patients who met the diagnostic criteria for panic disorder with depression (PD) were compared to 13 control cases (C). Arizona Sexual Experience Scale (ASEX) was used to measure sexual experience. Results. ASEX scores were significantly different between the three groups (P=0.001). In two group comparisons sexual desire and aversion subscores of ASEX were significantly decreased in group PD when compared with groups P and C (P=0.01). Also, our results show that the difference of orgasmic experience subscore of ASEX in groups PD and C was found to be statistically significant (P=0.01). On the other hand, there was no statistical difference between P and PD groups in terms of orgasmic experience (P=0.16). Conclusion. These results suggest that decreased sexual desire and high sexual aversion may be presenting symptoms of depression in patients with panic disorder. If there is no depression, patients with panic disorder should be questioned especially for orgasmic problems.

SEX DIFFERENCES AND SIMILARITIES IN FREQUENCY AND INTENSITY OF SEXUAL DESIRE

Only within the past decade have social scientists commonly recognized the phenomenon of sexual desire as a distinct and vital component of human sexual response. Of the various factors believed to be associated with sexual desire, gender (biological sex) is presumed by many theorists to be one of the most important. Limited empirical work suggests that men experience desire more frequently than do women; however, sex differences in intensity or level of desire have yet to be examined. This study explored both the self-reported frequency and intensity of sexual desire among an ethnically diverse sample of 676 men and women. As hypothesized, men reported experiencing a higher overall level of sexual desire than did women. Sex differences also were found with respect to frequency of sexual desire. Men reported experiencing sexual desire more often than did women and, when asked to estimate the actual frequency with which they experienced desire, men's estimated frequency (37 times per week) was significantly higher than women's (9 times per week). These results do not imply that men always feel desire or that women lack sexual desire. In fact, virtually every participant in this study reported feeling sexual desire on a regular basis. This suggests that desire may be the most universal sexual response experienced by both men and women.

Speech rate as a sticky switch: a multiple lesion case analysis of mutism and hyperlalia

Though it has long been known on the basis of clinical associations and serendipitous observation that speech rate is related to mood and psychomotor baseline, it is less known that speech rate is also related to libido and to immune function. We make the case for a bipolar phenomenon of "psychic tonus," encompassing all these dimensions. The elated, agitated, libidinal, immunofacilitated, and talkative pole is an "approach" disposition primarily activated by the normal left hemisphere-especially, though not exclusively, its frontal lobe. The dejected, lethargic, delibidinized, immunosuppressed, and mute pole is an "avoidance" disposition primarily activated by the normal right hemisphere-especially, though not exclusively, its frontal lobe. In support of this proposed model, we present new evidence, via meta-analysis of previously published single lesion case reports, of a highly significant association between right hemisphere lesions and non-aphasic hyperlalia, and between left hemisphere lesions and non-aphasic mutism.

Sexual dysfunction in Saudi depressed male patients

INTRODUCTION Sexual dysfunction is common among depressed male patients; however, its causes are complex and multifactorial. The aim of this study is to identify risk factors for sexual dysfunction associated with depression. METHODS One hundred and twenty-five consecutive depressed male patients were interviewed at Jeddah Psychiatric Hospital. They were divided in to two groups, on the basis of whether they had sexual dysfunction or not. These two groups were then compared on a number of potential risk factors, using chi-square and odds ratio. RESULTS The majority of patients had not previously been asked about sexual dysfunction. Seventy-seven (62%) presented with sexual dysfunction and 48 (38%) without. Marital difficulties, hypertension, diabetes, severity of depression and tricyclic antidepressants were significant risk factors. No association was found with demographic origin, occupation, education or marital status. These results are similar in some aspects to those reported in western studies. CONCLUSIONS (a) The majority of doctors do not take a sexual history despite its high prevalence. (b) Physical illness and overall severity of depression were important risk factors.

Erectile dysfunction and depression: category or dimension?

Depression, as a risk factor for erectile dysfunction (ED), has received minimal systematic attention. One-hundred twenty men with ED evaluated in a sexual behaviors clinic were studied. The categorical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnosis of a depressive disorder was found in only 14 subjects (14.7%). Dimensional quantification of depression was measured with the Brief Symptom Inventory (BSI). The BSI data revealed clinically significant elevations of depression and other dysphoric affects. The presence of a comorbid medical diagnosis did not affect the rates of categorical diagnosis of depression or the dimensional levels. The five factors of personality in the NEO-PI were within normal range. The data demonstrates that men with ED are affectively distressed but infrequently meet criteria for categorical DSM-IV depression.

Klinisch-psychologische Aspekte der erektilen Dysfunktion: Die Bedeutung psychosozialer Faktoren

Zusammenfassung.Theoretischer Hintergrund: In den vergangenen 20 Jahren hat der medizinische Erkenntnisfortschritt zu einer erheblichen Verbesserung der Diagnostik und Therapie von Erektionsstörungen geführt und die psychosoziale Dimension der Symptomatik nahezu in Vergessenheit geraten lassen. Fragestellung: In wie weit liegen für die an Entstehung und Aufrechterhaltung einer Erektionsstörung postulierten psychosozialen Faktoren empirisch gesicherte Erkenntnisse vor? Methode: Die Literatur zu klinisch orientierten Untersuchungen, epidemiologischen Studien und zu psychophysiologischen Laborexperimenten wurde analysiert. Ergebnisse: Der differenzierten Untersuchung psychischer Aspekte der Erektionsstörung wurde in der Forschung bisher wenig Aufmerksamkeit geschenkt. Die empirische Überprüfung der Annahmen, die der Sexualpsychotherapie zugrunde liegen, befindet sich noch in der Anfangsphase. Schlussfolgerungen: Es erscheint insbesondere notwendig, geeignete psychometrische Verfahren zur Diagnostik klinisch-psychologischer Aspekte von Erektionsstörungen zu entwickeln.

Sexual dysfunction in male posttraumatic stress disorder patients

BACKGROUND

Previous studies have suggested that sexual dysfunction may be associated with posttraumatic stress disorder (PTSD). Yet such studies have not examined a full range of sexual functioning and have not accounted for the possibility that medication used to treat PTSD may contribute to sexual dysfunction.

OBJECTIVE

The current study compares the various components of sexual functioning among three groups of males: (1) untreated PTSD patients (n = 15), (2) PTSD patients currently treated with selective serotonin reuptake inhibitor (SSRI) agents (n = 27) and (3) a group of normal controls (n = 49).

METHODS

All participants completed an 18-item questionnaire for assessment of sexual functioning. Those with PTSD also completed the Impact of Events Scale and the Symptom Check List-90 (SCL-90).

RESULTS

Untreated and treated PTSD patients had significantly poorer sexual functioning in all domains (desire, arousal, orgasm, activity and satisfaction) as compared to normal controls. Those treated with SSRI had greater impairment in desire, arousal and frequency of sexual activity with a partner. There was a high correlation between sexual dysfunction among the PTSD group and the anger-hostility subscale of the SCL-90.

CONCLUSIONS

PTSD appears to be associated with pervasive sexual dysfunction that is exacerbated by treatment with SSRIs. PTSD may represent a heterogeneous syndrome. Patients with PTSD have a high rate of comorbid panic disorder, major depression and anxiety, and it could thus be argued that these comorbid disorders, rather than PTSD, accounted for the observed result. Future research aimed at understanding comorbidity and heterogeneity should help to illuminate the psychobiology of PTSD and eventually guide both medication and psychosocial treatments.

The Arizona Sexual Experience Scale (ASEX): reliability and validity

Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated, user-friendly scales. In order to address this problem, the authors have developed the Arizona Sexual Experiences Scale (ASEX), a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Possible total scores range from 5 to 30, with the higher scores indicating more sexual dysfunction. This study assesses the internal consistency, test-retest reliability, and convergent and discriminant validity of the ASEX.

Sexual dysfunction before antidepressant therapy in major depression

BACKGROUND

Decreased sexual interest and function both occur as a consequence of antidepressant medication use, and are especially associated with serotonin reuptake inhibitors (SRIs). However, few investigators have reported the base rate for disturbances in sexual desire, arousal and orgasm or ejaculation in patients with major depression (MD) prior to antidepressant treatment. The purpose of this report is to define the frequency of sexual dysfunction (SD) in 134 patients with MD and examine the relationship between SD and demographic, clinical and personality variables.

METHOD

A consecutive series of 55 male and 79 female MD patients diagnosed by SCID-DSM IV assessment completed a series of psychometric measures including a Sexual Function Questionnaire, which asked about change in sexual interest and function as well as sexual activity during the preceding month.

RESULTS

Only 50% of women and 75% of men reported sexual activity during the preceding month. Over 40% of men and 50% of women reported decreased sexual interest. Reduced levels of arousal were more common in both men and women (40-50%) than ejaculatory or orgasm difficulties (15-20%). In women, problems with arousal and orgasm correlated with higher neuroticism and lower extraversion. There was no relationship between SD and personality measures in men. While age at onset of depression and number of prior episodes showed a modest correlation with SD measures, there were no correlations with severity of depression or specific symptoms clusters.

LIMITATIONS AND CONCLUSIONS

Although limited by a relatively small sample of drug free patients with MD, and by the absence of a non-depressed comparison sample, these results emphasize the importance of factors beyond specific drug effects in the assessment of antidepressant related sexual dysfunction.

Effects of withdrawal from an escalating dose schedule of d-amphetamine on sexual behavior in the male rat

The present study sought to determine the effect of withdrawal from an escalating dose schedule of d-amphetamine on sexual behavior in male rats. Tests were conducted every 5 days until stable levels of sexual behavior were obtained. With repeated testing, male rats displayed an increase in their exploration of the testing chambers prior to the introduction of an estrous female. Half of the male rats were then subjected to a 4-day escalating dose schedule of d-amphetamine administration (1-12 mg/kg), while half received vehicle. Twelve hours after the final drug injection, subjects were tested for sexual behavior. Withdrawal from the drug was associated with decrements in several motivational components of sexual behavior, including decreased anticipatory locomotor and increased postejaculatory intervals, while consummatory measures remained largely unaffected. This pattern of sexual deficits resembles those seen in human depressive disorders, and therefore, provides additional support for the use of psychostimulant withdrawal as a rodent model of depression.

The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study

OBJECTIVE

Studies have shown that there is an association between depression and male erectile dysfunction (MED). However. these earlier studies suffer considerable methodological flaws including: a) lack of a multidisciplinary approach; b) poor sampling techniques; and finally, c) poor and variable measures of MED and depression. Our objectives are: a) to determine whether MED is associated with depressive symptoms and b) to determine whether this association is independent of aging and para-aging factors.

METHOD

Data were obtained from the Massachusetts Male Aging Study (MMAS). The MMAS was a cross-sectional, population-based multidisciplinary survey of health in normally aging men (aged 40-70 years) conducted from 1986 to 1989. In the analytic model, depressive symptoms, as measured by a score of 16 or greater on the Center for Epidemiological Studies-Depression (CES-D) scale, was used as a predictor of MED, which was assessed with a self-administered questionnaire.

RESULTS

MED was associated with depressive symptoms after controlling for potential confounders (odds ratio (OR) 1.82, 95% confidence interval (Ct) 1.21-2.73).

CONCLUSIONS

We conclude that the relationship between depressive symptoms and MED in middle-aged men is robust and independent of important aging and para-aging confounders, such as demographic, anthropometric and lifestyle factors, health status, medication use, and hormones.

Compliance during treatment with antidepressants

Compliance has become a topic of intense investigation and debate during the past two decades. The present review first examines to what factors the exponential increase in research studies on the topic can be attributed. A second part summarizes the history of the concept, the definitions and measurements of compliance and the estimations of compliance and non-compliance. Studies searching for relevant components of compliance behavior can be divided in two groups. A first group of publications originates from a biomedical and pharmaceutical approach, and investigates which characteristics of illness, of drug regimen or drug side effects, of patients, doctors or their practices can predict the variance in compliance. The implicit aim of these studies is the development of strategies leading to increased compliance. A second group of publications originates from medical psychology (psychodynamic, cognitive-behavior and interactional considerations) and investigates why a given patient is compliant or not, sometimes even suggesting that non-compliance can even be a meaningful response. The present review suggests that the relation between the occurrence of side effects and non-compliance during treatment with antidepressant drugs is more complex than usually accepted and that, in case of non-compliance, finding an equilibrium between authoritarian tactics and passive avoidance does remain one of the challenges in daily practice.

Advances in the management of depression: implications for the obstetrician/gynecologist

The selection of an appropriate medication is important for successfully treating depression in women. Although antidepressants do not differ in their efficacy for the treatment of major depression, they do differ in their side effect profiles, toxicity, and mechanisms of action. Tricyclics, heterocyclics, and newer agents such as bupropion, fluoxetine, paroxetine, sertraline, and venlafaxine are used most commonly to treat depression in women. The dosages, side effects, indications, and precautions for these antidepressants are reviewed. Factors affecting selection of a particular antidepressant, as well as the general management of depression in women, are discussed.

Self-report assessment of female sexual function: psychometric evaluation of the Brief Index of Sexual Functioning for Women

Previous self-report measures of female sexual function have been either overly restrictive or inappropriate for use in large-scale clinical trials. Accordingly, we have developed the Brief Index of Sexual Functioning for Women (BISF-W), a 22-item, self-report instrument for the assessment of current levels of female sexual functioning and satisfaction. The BISF-W was administered at monthly intervals to a standardization sample of 269 women, ages 20-73 years. A principal components analysis yielded a three-factor solution--interest/desire, sexual activity, and satisfaction--which accounted for 51.2% of the variance. Concurrent validity was demonstrated by means of a comparison with the Derogatis Sexual Function Inventory. In addition, the BISF-W was compared to the Brief Sexual Function Questionnaire, a similar self-report measure of sexual functioning for men. Major advantages of the BISF-W are its ease of administration and scoring, suitability for use in both clinical and nonclinical samples, and assessment of key dimensions of female sexuality. However, based on its moderate test-retest reliability and internal consistency, further development of the instrument is indicated.

Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a Brief Sexual Function Questionnaire for men

We report a study of sexual function in outpatient men with major depressive disorder (n = 42), compared with healthy control men (n = 37) and a clinic sample complaining of erectile dysfunction (n = 13). A principal-components factor analysis of the Brief Sexual Function Questionnaire confirmed differences in the clinical dimensions of sexual activity/performance, interest, satisfaction, and physiological competence. The four factors accounted for 72% of the variance in the analysis. Acceptable test-retest reliability, construct validity, and concurrent validity (with the Derogatis Sexual Function Inventory and a self-report behavioral log) were demonstrated. Parallel observations with findings from previous nocturnal penile tumescence studies in these same men are discussed.

Nocturnal penile tumescence is diminished in depressed men

Although depressed individuals commonly report decreased libido, it was not known if such changes are accompanied by neurophysiological alterations. Preliminary studies suggest that some depressed men may manifest diminished nocturnal penile tumescence (NPT), an objective measure of erectile capacity. We report NPT findings in 34 male outpatients with major depression (SADS/RDC) and an age-matched group of 28 healthy controls. A 3-night electroencephalographic (EEG) sleep/NPT protocol was utilized, with penile rigidity (buckling force) determined on night 3. Analysis of night 2 data by MAN-COVA revealed significant effects for age, the covariate (F = 2.86, p = 0.002), and diagnosis (F = 2.32, p = 0.02). Depressed men had significantly diminished NPT time (F = 16.8, p less than 0.001), even when adjusted for sleep time (F = 13.4, p less than 0.001) or rapid eye movement (REM) time (F = 7.2, p less than 0.01). NPT time was reduced by greater than or equal to 1 SD below the control mean in 40% of depressives and was comparable to the level seen in 14 nondepressed patients with a clinical diagnosis of organic impotence. An intermediate proportion of depressed patients (38%) had maximum buckling forces less than or equal to 500 g, indicating diminished penile rigidity, when compared to controls (16%) and men with presumed organic impairment (93%) (p less than 0.001). Diminished NPT time and low buckling force were associated with a history of erectile dysfunction within the index depressive episode (p less than 0.001). These findings suggest that depression in men is associated with a potentially reversible decrease in erectile capacity, which may be associated with significant sexual dysfunction.