A 41 y/o male presents with complaints of inability to achieve proper erections during sexual intercourse. He repos that there were no abnormalities till last month, when on one occasion he tried having sex with wife while he was drunk. He was not able to achieve a proper erection at that time and since than, on four other occasions , he was not able to have an erection during attempted sex. He repos that his morning erections are fine and erection during masturbation was also normal. He is a diabetic, and the blood repos show, FBS-103 mg/dl, HbA1C- 6.6. His BP was 138/88 mm Hg What is the likely cause of erection disturbances?
High-Yield Explanation
History of sudden onset, normal morning erections and normal erection during masturbation is suggestive of Psychogenic Erectile dysfunction. The cause is usually performance anxiety. To differentiate between psychogenic and organic erectile dysfunction best test is ask for nocturnal / early morning erections as patient is relaxed in these conditions. So in the above case it rules out all organic causes.