Psychogenic Impotence:
Performance Anxiety
Patient Identification: JTG
General Medical Hx
Self-employed real estate agent, married x 2(#1 lasted 4 years; #2 lasted 9 years), wife is 33 years old, 2 children
age: 38
med.dx : multiple sclerosis, diagnosed 1976
surgeries: appendectomy, 1951
smoker: no
alcohol: occasional wine
meds: Elavil 10-20 mg. q.d.(neck pain)
Sexual Hx
• difficulty maintaining erections since 5/84 (tires more easily secondary
to MS)
• complains of decreased penile sensation
• rapid onset of sexual dysfunction (noted concurrent business stress at
that time)
• good nocturnal and A.M. erections
• erotic films and reading material improve duration of erections
• erections sufficient for vaginal penetration, but has difficult maintaining
erections
• penile curvature: denies
• last successful intercourse: 3 weeks ago
• ejaculation intact – intercourse
• premature ejaculation: denies
• libido: normal
• increased marital discord secondary to sexual dysfunction
• bladder symptoms: frequency, urgency and difficulty starting stream
• bowel symptoms: denies
• sleep disturbances: denies
Physical Exam
Findings consistent with MS diagnosis
Test Results
RigiScan: NI. x 3 nights – NI. Tumescence and rigidity of base and tip of
penile shaft
Final Dx
Performance dysfunction associated with weakness and spasticity secondary to MS causing fear of failure to perform
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