ReviewContextual approaches to the physiology and classification of erectile function, erectile dysfunction, and sexual arousal
Section snippets
Contexts for erection
My use of “context” may best be paraphrased as “stimulus complex,” and refers to the set of stimuli that comprise each organism's environment. This set would include the social, external physical, and internal physical stimuli (including circadian and other rhythms) that characterize the situation in which erection develops, with due consideration of the developmental and experiential history of the individual male.
Properties of erection vary with context
The distinctions being made among erectile contexts should not of themselves be construed as indicating that there are different “types” of erection. Pending evidence to the contrary, it is reasonable to suppose that the characteristics of human erection are similar across different contexts. However, in rats the physical and temporal features of erection clearly vary according to context, as the upper portion of Table 3 shows (modified from Ref. [105]). For example, although tumescence of the
Physiology of erection varies with context
In addition to context-dependent changes in the spatiotemporal properties of erection, the physiology of erection also varies with context (Table 3, lower portion). The foundations for this idea were laid at least 50 years ago. However, some of those foundations were flawed, and the several different contexts have usually been reduced to the reflexive–psychogenic dichotomy that, as noted above, seems to be untenable. Because the differential physiological regulation of erection in different
Implication for distinction between organic and psychogenic erectile dysfunction
If the physiology of erectile function varies significantly from one context to another, then it follows that the physiology of erectile dysfunction (ED) may also vary from context to context. This principle is receiving greater recognition, but one can find recent examples of failure to recognize it, especially in certain attempts by clinicians to determine whether instances of ED are due to “organic” or “psychogenic” causes. For decades, sleep-related erection (SRE) was the test of first
A contextual definition of sexual arousal
The recent availability of effective drug treatments for ED has made clear how much less we understand about the mediation of two other processes related to erectile function: sexual arousal and sexual motivation. (The latter term is also commonly referred to as sexual desire or libido.) Only sexual arousal will be addressed in detail here. Further on, I will make explicit why I consider it important to distinguish between sexual arousal and desire (see Section 5.3).
The concept of sexual
Conclusion
On the evidence reviewed here, it is not true that an erection is an erection is an erection. Though erections share many features, it becomes clear when one looks more closely at the erectile context that there are striking differences in the physiology of erection and even in the form and temporal patterning of erection. Because there is value in considering context for erectile function, there may also be value in viewing erectile dysfunction from a similar perspective. For example, the
Acknowledgements
Supported by NSF research grant IBN-9603917. Discussions with John Bancroft, Ross Buck, François Giuliano, Erick Janssen, James Pfaus, Raymond Rosen, Jacqueline Sachs, John Salamone and several other colleagues over the past few years helped to shape the ideas presented in this paper, in some cases despite their express disagreement. I thank Jacqueline Sachs, Raymond Rosen and an anonymous referee for their valuable suggestions on the manuscript itself.
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