Guide to treatment and short-term prognosis of male potency disorders in hospital and general practice.

There are three main ways in which male sexual potency may be impaired: impotence-the persistent inability to develop or sustain an erection sufficient to conclude coitus to orgasm and ejaculation; impotentia ejaculandi-the persistent absence of orgasm and ejaculation during coitus (which may be greatly prolonged), despite the presence of normal desire and erection; and premature ejaculation-the persistent occurrence of ejaculation and orgasm against volition, and before the male wishes, before or immediately after penetration. Owing to inadequate stimulation by the male partner the female may also experience a reduced orgasm; this is more likely in impotence and premature ejaculation than in impotentia ejaculandi. Disorders of male sexual potency may be predominantly "organic" or "psychological," though in some cases both of these factors may operate and overlap and complicate each other. "Organic" disorders of potency are persistent; irrespective of the type or intensity of the sexual stimulation they remain unchanged. Organic impotence may occur with any debilitating disease-for example, metabolic disorders, disorders of the central nervous system, cardiovascular disease, after the use of drugs, and with endocrinopathies. Most authorities believe that organic disorders are relatively rare and that in over 90% of cases psychogenic factors dominate. This article is concerned with the latter type of disorder. Most people think that psychogenic potency disorders are best treated by the psychiatrist, psychoanalyst, or medical psychologist. Because of this, the general practitioner-who is often the first to be consulted-might be discouraged from trying to treat these patients, thinking in addition that he is unequipped technically to deal with them, or that their disorders require protracted psychiatric treatment over months or years, or that they have a poor prognosis anyway. This article, based on some recent findings,' 2 I is designed to reassure the general practitioner that not only are these problems well within his competence, but that they are rewarding to treat. In particular, it aims to help him in the careful selection of patients since this ensures a satisfactory treatment response in a high percentage of cases. Before starting treatment it is important to obtain a detailed psycho-sexual history from both sexual partners. An essential requirement for successful treatment is the full cooperation and active participation of the female partner; without this it is doubtful whether much can be achieved.