Diagnosis and treatment of male sexual dysfunction.

This paper presents a critical review of recent work on diagnosis and treatment of male sexual dysfunction. One recent advance has been a focus on low sexual desire in males. Hormonal disorders are relatively uncommon in such men, with family-of-origin and couple-dynamic issues usually cited in the clinical literature as major etiologic factors. Recent work on erectile failure has focused on differential diagnosis of physiological and psychological factors in erectile failure. To date, no simple differential diagnostic procedure has been identified, and a complex and expensive multidimensional evaluation is required for accurate diagnosis. Treatment for premature ejaculation continues to be very effective, but an understanding of the mechanism underlying treatment effectiveness has remained elusive. The cause of inhibited ejaculation also continues to be unclear, although medication side effects have been recognized as a common contributing factor. Across all the male dysfunctions, clinical reports have outweighed empirical studies in the recent literature. Heterogeneity of patient groups, lack of objective outcome measures, lack of control groups, and other basic methodological problems, continue to plague this area of research.