428 Sexual Dysfunctions
limiting or responsive to ps ychological interventions, wher eas, as noted above, acquired
erectile disorder is more likely to be related to biological factors and to be persistent. The
incidence of erectile disorder increases with  age. A minority of men diagnosed as having
moderate erectile failure ma y experience spontaneous remission of symptoms without
medical intervention. Distress as sociated with erectile disord er is lower in older men as
compared with younger men.
Risk and Prognostic Factors
Temperamental. Neurotic personality traits may be associated with erectile problems in col-
lege students, and submissive personality traits may be associated with erectile problems in
men age 40 years and older. Alexithymia  (i.e., deficits in cognitive processing of emotions) is
common in men diagnosed with “psychogenic” er ectile dysfunction. Erectile problems are
common in men diagnosed with depression and posttraumatic stress disorder.
Course modifiers. Risk factors for acquired erectile disorder include age, smoking to-
bacco, lack of physical exercise, diabetes, and decreased desire.
Culture-Related Diagnostic Issues
Complaints of erectile disorder have been foun d to vary across countries. It is unclear to
what extent these differences represent differ ences in cultural expectations as opposed to
genuine differences in the fr equency of erectile failure.
Diagnostic Markers
Nocturnal penile tumescence testing and meas ured erectile turgidity during sleep can be
employed to help differentiate organic from  psychogenic erectile problems on the as-
sumption that adequate erections during ra pid eye movement sleep indicate a psycholog-
ical etiology to the problem. A number of other diagnostic procedures may be employed
depending on the clinician’s assessment of their relevance given the individual’s age, co-