Ejaculatory incompetence following penile prosthesis implantation in men with primary psychogenic impotence
Lawrence M. Martin, M.D.
Department of Psychiatry
Drogo K. Montague, M.D.
Department of Urology
Surgical implantation of synthetic material into the substance of the penis for the treatment of erectile impotence was first reported in 1952.1 In the ensuing 30 years prosthesis design and surgical technique have undergone continued development and refinement. Many thousands of men worldwide with erectile failure of diverse etiology have now experienced operative restoration of copulatory capacity through penile prosthesis implantation. Follow-up studies have reported patient satisfaction rates in the 89%–95% range.2–4
The great majority of implant recipients have carried a preoperative diagnosis of biogenic impotence. For patients with psychogenic impotence psychological treatment approaches such as directive sex therapy, psychotherapy, or marital therapy have generally been regarded as more appropriate. Most urologists doing prosthesis surgery have been willing, however, to do prosthesis implantation in selected patients with psychogenic impotence. Typically these patients have failed to respond to previous efforts at psychological treatment. In the only follow-up study that specifically addresses the issue, Gerstenberger et al2 found that prosthesis recipients with biogenic and psychogenic preoperative diagnoses did not differ in the postoperative level of satisfaction. Of their 61 operated patients, 11 had psychogenic impotence, but the authors did not specify the pattern of impotence (primary or secondary, total or partial) in their psychogenic group. We report here on two patients with primary psychogenic erectile dysfunction who received a penile prosthesis at our center.
Case 1. A never married 48-year-old white man presented with a long-standing history of impotence, dating to his first coital attempt at age 23.