Arousal Disorders · Clinical Exercise

Where the Erection Works

Three questions settle most arousal presentations: morning erections, erection during masturbation, and whether the difficulty is present in every context. Six presentations to place on a grid built from those answers, and the two conversations that follow.

What this exercise practises

Reading two variables rather than one before deciding whether a presentation is psychological or needs assessing, explaining the performance anxiety cycle mechanically rather than reassuringly, and delivering a medical referral that gets acted on.

One of the six is a referral most clinicians would miss. One is a referral most would make unnecessarily. Both errors come from reading one variable instead of two.

Estimated time to complete this exercise: 25 minutes

1The grid
2The cycle
3The referral
4Close

Before you begin

How this one works

Three questions settle most arousal presentations: are there morning erections, is there erection during masturbation, and is the difficulty present in every context. This exercise is those three questions turned into a grid.
Part 1 gives you six presentations to place. Two of them are referrals you might not make, one of them is a referral you might make too readily, and one is normative change rather than a disorder.
Parts 2 and 3 are the two conversations. The first is the performance anxiety cycle explained to a client. The second is a medical referral delivered without turning it into a cardiac warning.
Nothing is graded and nothing is recorded. Reloading starts it again.

Situationality is the single most diagnostically efficient indicator in arousal presentations. Consistent difficulty across all contexts points towards organic contributors. Difficulty confined to particular partners or contexts points almost always towards relational, psychological or contextual ones.

References

  1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
  2. Corona, G., Rastrelli, G., Morgentaler, A., Sforza, A., Mannucci, E., & Maggi, M. (2016). Meta-analysis of results of testosterone therapy on sexual function based on International Index of Erectile Function scores. European Urology, 70(6), 1012–1022. https://doi.org/10.1016/j.eururo.2016.05.013
  3. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54–61. https://doi.org/10.1016/S0022-5347(17)34871-1
  4. Inman, B. A., St. Sauver, J. L., Jacobson, D. J., McGree, M. E., Nehra, A., Lieber, M. M., Roger, V. L., & Jacobsen, S. J. (2009). A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clinic Proceedings, 84(2), 108–113. https://doi.org/10.4065/84.2.108
  5. Nimbi, F. M., Tripodi, F., Simonelli, C., & Tambelli, R. (2020). Expanding the analysis of psychosocial factors of sexual desire in men. Journal of Sexual Medicine, 17(1), 67–76. https://doi.org/10.1016/j.jsxm.2019.10.002