The ability to perform sexually and satisfy a partner is frequently perceived by men as defining their masculinity. Erectile dysfunction (ED) and loss of erection hardness can have a profoundly adverse effect on their psychological well-being. The loss of self-esteem associated with ED may, in turn, have an impact on their relationship with their sexual partner, which may result in a withdrawal from intimacy and of affection by their partner, leading to a vicious circle of behavioural change that may further compound the damage to the relationship and both partners psychological well-being. In some men, psychosocial distress caused by ED may develop into secondary depression, or it may aggravate depressive tendencies. This synergistic interaction between ED, depression, and physical illness means that a correct differential diagnosis is essential to target treatment on the leading cause of depression. Phosphodiesterase type 5 (PDE5) inhibitors have been used successfully to improve erection hardness in men with depression both alone and in combination with antidepressant therapy. Furthermore, recent prospective studies have demonstrated that by increasing erection hardness and the frequency of successful intercourse attempts, effective treatment of ED has positive effects on a man's psychological health and quality of sex life. The result is an increased desire for sexual intimacy that improves a man's relationship with his partner and overall life satisfaction.
Keywords: Depression, Emotional impact, Erectile dysfunction, Erection hardness, PDE5 inhibitors, Psychological health, Self-esteem, Sexual satisfaction.
a The Prostate Centre, London, United Kingdom
b Vocational Training Department of General Practice, Julius Center for Health Sciences and Primary Care, The Netherlands
c Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Milano, Italy
d Specialty School in Obstetrics–Gynecology, University of Florence, Italy
e 2nd Department of Urology and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece
f Queen's University, Kingston, Canada
g European Sexual Dysfunction Alliance (ESDA) 1998–2005, Spain
h Sexual Dysfunction Alliance (SDA) 1996–2005, UK
© 2006 European Association of Urology, Published by Elsevier B.V.