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REPORTS: Considerations for Diagnostic Criteria for Erectile Dysfunction in DSM V


Robert Taylor Segraves, MD, PhD, Department of Psychiatry, Metrohealth Medical Center, 2500 Metrohealth Drive Cleveland, Ohio 44109. Tel: 216 778 4637; Fax: 216 778 2397; E-mail:


Introduction.  The Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., text revision (DSM-IV-TR) criteria for erectile disorder have been criticized as multiple grounds including that the criteria lack precision, that the requirement of marked distress is inappropriate, and that the specification of etiological subtypes should be deleted.

Aim.  The goal of this manuscript is to review evidence relevant to diagnostic criteria for erectile disorder published since 1990.

Method.  Medline searches from 1990 forward were conducted using the terms erectile disorder and impotence. Early drafts of proposed alterations in diagnostic criteria were submitted to advisors.

Main Outcome Measure.  Evidence regarding modification of criteria for DSM V diagnostic criteria for erectile dysfunction was judged by whether existing data justified the adoption of precise criteria which would lead to homogenous groups for research. Another outcome measure was whether data exist to reliably differentiate fluctuations in normal function from pathological states.

Results.  The literature review revealed a large literature concerning erectile disorder but minimal evidence concerning an operational definition for this disorder.

Conclusions.  It is recommended that erectile disorder be precisely defined in order to clearly differentiate alterations in normal function from a condition requiring medial intervention and to facilitate clinical research. It is specifically proposed that erectile dysfunction be defined as failure to obtain and maintain an erection sufficient for sexual activity or decreased erectile turgidity on 75% of sexual occasions and lasting for at least 6 months. It is also recommended that erectile disorder be defined independently of distress. Segraves RT. Considerations for diagnostic criteria for erectile dysfunction in DSM V. J Sex Med 2010;7:654–671.

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