Because the brain is intimately involved in the control of erections, a wide variety of psychological factors impact erectile response and may lead to erectile dysfunction (ED).

This chapter reviews the assessment of psychological factors in ED, the immediate and underlying psychological conditions involved, and the development of ED over time. Outcome research on psychological treatments for ED is also reviewed. The goal of the chapter is to help health care providers to conduct a comprehensive evaluation of ED that is sensitive to psychological factors.

A comprehensive understanding of erectile dysfunction (ED) must incorporate both the physical and the psychological aspects of erectile response. An erection is best characterized as a psychophysiological phenomenon that depends on a complex interplay of biological and psychological factors. Impairment in any of these aspects may lead to erectile dysfunction. The focus of this chapter is on the assessment of psychological factors that contribute to erection difficulties. The evidence regarding the outcome of psychological treatments and the integration of medical and psychological treatments are also reviewed.

The definition of psychological factors to be used here encompasses a variety of mental aspects of sexuality.

  1. First are the behavioral aspects, which primarily involve who does what to whom in the sexual encounter.
  2. Second are the emotional aspects of the sexual response, that is, feelings during sex, as well as the emotional needs associated with sex.
  3. Third are the cognitive aspects of sexual response, which include knowledge, beliefs, and attitudes about sexuality.
  4. Fourth are the interpersonal aspects, i.e., the couple’s interaction and the quality of the relationship, both sexual and emotional.
  5. Fifth are the cultural aspects of sexuality, which entail the expectations and norms that shape sexual behavior.

It is also important to note that, while most of these aspects of sexuality are either observable or may be described by the patient, much of what is referred to as psychological is either unconscious or inaccessible to the individual himself.