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Psychological Determinants of Erectile Dysfunction: Testing a Cognitive–Emotional Model


Pedro Nobre, PhD, Rua Amorim de Carvalho, 97, 4460 SENHORA DA HORA, Portugal. Tel: +351 22 9386958/+351 91 9552134; Fax: +351 234 370640; E-mail:


Introduction.  Recent studies have shown the impact of sexual dysfunctional beliefs, negative cognitive schemas, negative automatic thoughts, and depressed affect on male erectile dysfunction. Despite this fact, there are only few conceptual models that try to integrate these findings, and more importantly, there is a lack of studies that test the validity of those conceptual models.

Aim.  The aim of the present article was to test a cognitive–emotional model for erectile dysfunction. Taking previous research findings into account, we developed a cognitive–emotional model for erectile disorder (ED) and used path analysis to test it.

Methods.  A total of 352 men (303 participants from the general population and 49 participants with a DSM-IV diagnosis of sexual dysfunction) answered a set of questionnaires assessing cognitive and emotional variables.

Main Outcome Measures.  Erectile Function measured by the EF subscale of the International Index of Erectile Function, cognitive schemas measured by the Questionnaire of Cognitive Schema Activation in Sexual Context, sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions measured by the Sexual Modes Questionnaire.

Results.  The effects of the main proposed direct predictors explained 55% of the erectile function variance (R = 0.74). Most remaining direct effects proposed in the model were also statistically significant. The analysis of the absolute residuals showed that most of the implied correlations were close to the observed zero order correlations, indicated the adjustment of the model to the observed data.

Conclusions.  These findings support the role played by cognitive and emotional factors on the predisposition and maintenance of male erectile dysfunction and suggest important implications for assessment and treatment of ED. Nobre PJ. Psychological determinants of erectile dysfunction: Testing a cognitive–emotional model. J Sex Med 2010;7:1429—1437.