Female Orgasmic Disorder 429
Substance/medication use. Another major differential diagnosis is whether the erectile
problem is secondary to substa nce/medication use. An onset that coincides with the be-
ginning of substance/medication use and that dissipates with discontinuation of the sub-
stance/medication or dose reduction is su ggestive of a substance/medication-induced
sexual dysfunction.
Another medical condition. The most difficult aspect of the differential diagnosis of erec-
tile disorder is ruling out erec tile problems that are fully explained by medical factors. Such
cases would not receive a diagnosis of a ment al disorder. The distinction between erectile
disorder as a mental disorder and erectile dy sfunction as the result of another medical con-
dition is usually unclear, and many cases will have complex, interactive biological and psy-
chiatric etiologies. If the individual is older than 40–50 years and/or has concomitant
medical problems, the differential diagnosis should include medical etiologies, especially
vascular disease. The presence of an organic disease known to  cause erectile problems does
not confirm a causal relationship. For exampl e, a man with diabetes mellitus can develop
erectile disorder in response to psychological stress. In general, erectile dysfunction due to
organic factors is generalized and gradual in onset. An exception would be erectile problems
after traumatic injury to the nervous innervation of the genital organs (e.g., spinal cord injury).
Erectile problems that are situational and inco nsistent and that have an acute onset after a
stressful life event are most often due to psychological events. An age of less than 40 years is
also suggestive of a psychologi cal etiology to the difficulty.
Other sexual dysfunctions. Erectile disorder may coexist with premature (early) ejacu-
lation and male hypoactive sexual desire disorder.