Impotence: are the newer diagnostic methods a necessity?

Until recently our evaluation of impotent men included a psychiatric evaluation, and history and physical examination by a urologist to determine whether the impotence was organic or psychogenic. After the introduction of specific laboratory methods, such as nocturnal penile tumescence monitoring and penile blood pressure studies, clinicians relied heavily on these tools. We evaluated 33 impotent patients and compared the results of the laboratory methods to the initial diagnoses of the psychiatrist and the urologist to determine if the new methods would confirm our initial impressions or uncover different diagnoses. Thirteen patients were considered to have psychogenic impotence by the clinicians and only 1 patient in this group had evidence of organicity when the laboratory tests were used. Twelve patients were considered to have organic impotence by the clinicians and this was confirmed in 75 per cent of the cases by laboratory testing. Thus, clinical evaluation predicted the outcome of laboratory methods in 92 per cent of the psychogenic group and 75 per cent of the organic group. In addition, postage stamps were used during nocturnal penile tumescence monitoring and in predicting the outcome of nocturnal tumescence monitoring the stamp test had a sensitivity and a specificity of 91 per cent. Many patients presenting with erectile impotence can be evaluated adequately by a psychiatrist and a urologist without the support of expensive laboratory tests. The postage stamp test is useful when nocturnal penile tumescence monitors are not available. Finally, the Minnesota Multiphasic Personality Inventory is of limited value as a screening device.