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December 8, 2004

Male Sexual Dysfunction—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(22):2722-2723. doi:10.1001/jama.292.22.2722-b

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.