Еректильна дисфункція: терміни, визначення, частота

As clinicians have observed, erectile disorders occur more frequently than other sexual dysfunctions in males seeking medical advice. This article deals with the terms used for defining disturbances of erection. In the author’s opinion, a commonly used term “erectile dysfunction” (ED) is actually much wider than the states it defines. This is due to the fact that disturbances of erection can be manifested by not only its weakening (hypoerection) or absence (anerection), but increasing (hypererection that occurs in cases of priapism and pseudopriapism) as well. It is noted that the term “erectile dysfunction” replaced the term “impotence”, which with time acquired a derogative tint (impotence → impotent). Nevertheless, in order to define somatogenic hypo(an)erection ICD-10 still used the category “impotence of organic origin”, which is absent in ICD-11. The article also analyses such terms and concepts as “impotentia coeundi” (the collective name for all sexual dysfunctions) and “impotentia generandi” (inability to reproduce, sterility). It is noted that earlier the term “impotence” was used for defining various sexual dysfunctions in females too. Definitions and diagnostic criteria for hypo(an)erectile disturbances in international (ICD-9, ICD-10 and ICD-11) and American (DSM-4 and DSM-5) classifications are given and discussed. The author believes that, according to the latest classifications, the ability to diagnose a sexual dysfunction (including ED) only in case when this problem persists for a long period of time (a few months, six months) is not reasonable. If a person is not treated during this period, the quality of his life can significantly aggravate, and he can develop disorders of the neurotic level. Sometimes within this time period the dysfunction may be eliminated spontaneously. In case with a specialist in clinical sexology, who is sufficiently experienced, he will be able to make an appropriate diagnosis within a much shorter period than it is envisaged by the given diagnostic criterion. Another diagnostic criterion used in latest classifications is also worth discussing, according to which the diagnosis of any sexual dysfunction can be established in the presence of clinically significant distress. It is the author’s opinion that the use of the above diagnostic criterion can distort the diagnostic process. In particular, it should be noted that in some males the present ED or any other sexual dysfunction really сan not cause any clinically significant distress, but this fact does not cancel their presence and should not become the reason for which this dysfunction cannot be diagnosed. Otherwise, we can talk about subjectification of the situation and overstepping of the medical field boundaries by diagnostics. The article also contains different data on the prevalence of ED. Conclusions. Special attention is paid to such criteria as the duration of the disorder (from several months to 6 months) and the mandatory presence of clinically significant distress. However, the requirement for a long course of sexual dysfunction is not justified, since during this time the patient’s quality of life can deteriorate significantly, and sometimes the disorder can disappear on its own. In some cases, the existing ED does not cause distress, but this should not be a reason for refusing to establish a diagnosis. The above statistics indicate a high prevalence of ED among men of different ages, which confirms the relevance of the problem and the need for its further study.