Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: The ability to achieve a firm erection
under nonsexual circumstances strongly suggests a psychogenic etiology for
erectile dysfunction because it indicates intact vascular mechanisms within
the corpora cavernosa.1 When this history is
lacking, nocturnal rigidity testing can also be a useful test to identify
psychogenic erectile dysfunction because men lack awareness of their sleep
erections and these therefore cannot be compromised by anxiety. The “stamp
test” (wrapping the penis at bedtime with a roll of 1-cent stamps, and
determining if the roll was broken in the morning, indicating an erection
had occurred) was used for many years, but lacks reliability because the test
may falsely indicate that an erection had occurred when there may have been
only partial or brief rigidity. The value of diagnosing psychogenic erectile
dysfunction is that clinicians may then offer nonpharmaceutical treatments,
such as psychotherapy or counseling. However, many men will reject any suggestion
to obtain counseling or undergo psychotherapy, although they may be quite
open to the idea of taking a pill to “fix” their problem.
Morgentaler A. Male Sexual Dysfunction—Reply. JAMA. 2004;292(22):2722–2723. doi:10.1001/jama.292.22.2722-b
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