Psychogenic impotence is commonly encountered in clinical settings. Yet making the diagnosis of a psychogenic origin of impotence is not so simple. Our aim was to compare the pharmacologic erection test in conjunction with visual sexual
stimulation(VSS)
with nocturnal penile tumescence (NPT) monitored by the Rigiscan for the diagnosis of psychogenic impotence. We analyzed 30 patients whose histories suggested psychogenic impotence, all of whom underwent both the pharmacologic erection test using
PGE1
with VSS and Rigiscan monitoring for three consecutive nights. If the results suggested organic impotence, the patients underwent penile duplex Doppler sonography, dynamic infusion cavernosometry and cavernosography, a bulbocavernous reflex
latency
test, and neurologic examination. In 24 patients(80%), psychogenic impotence was diagnosed; the remaining 6 patients proved to have organic impotence (5 vasculogenic, 1 neurogenic). In the psychogenically impotent patients, the pharmacologic
erection
test with VSS revealed a variety of findings; 11 patients(46%) had full erection and rigidity sufficient to perform intercourse, 4 patients had partial penile rigidity and erection that was insufficient to perform intercourse, 4 patients had
partial
penile rigidity and erection that was insufficient to perform intercourse, and the remaining 9 patients did not demonstrate penile rigidity or erection and are unable to perform intercourse. However, by NPT, all patients showed greater than 70%
rigidity
in both the proximal and the distal portion of the penis (proximal 87%; distal 88%). In addition, the circumference of both the proximal and the distal penis increased more than 2cm(proximal 3.76cm; distal 3.6cm). The six patients who were found
to
have
organic impotence demonstrated abnormal findings in both tests.
Our results suggest that the pharmacologic erection test with VSS may not be an appropriate way to distinguish between organic and psychogenic causes of impotence. However, the NPT test monitored by the Rigiscan is effective and efficient for the
diagnosis of psychogenic impotence and should be the primary test in patients in whom a psychogenic cause is suspected.
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