Psychogenic Impotence:

Performance Anxiety

   Patient Identification: JTG

 

General Medical Hx

Self-employed real estate agent, married x 2(#1 lasted 4 years; #2 lasted 9 years), wife is 33 years old, 2 children

 

age:             38

med.dx :      multiple sclerosis, diagnosed 1976

surgeries:    appendectomy, 1951

smoker:       no

alcohol:       occasional wine

meds:           Elavil 10-20 mg. q.d.(neck pain)

 

Sexual Hx

•   difficulty maintaining erections since 5/84 (tires more easily secondary

    to MS)

•   complains of decreased penile sensation

•   rapid onset of sexual dysfunction (noted concurrent business stress at

    that time)

•   good nocturnal and A.M. erections

•   erotic films and reading material improve duration of erections

•   erections sufficient for vaginal penetration, but has difficult maintaining

    erections

•   penile curvature: denies

•   last successful intercourse: 3 weeks ago

•   ejaculation intact – intercourse

•   premature ejaculation: denies

•   libido: normal

•   increased marital discord secondary to sexual dysfunction

•   bladder symptoms: frequency, urgency and difficulty starting stream

•   bowel symptoms: denies

•   sleep disturbances: denies

 

Physical Exam

Findings consistent with MS diagnosis

 

Test Results

RigiScan: NI. x 3 nights – NI. Tumescence and rigidity of base and tip of

penile shaft

 

Final Dx

Performance dysfunction associated with weakness and spasticity secondary to MS causing fear of failure to perform