During evaluation of erectile dysfunction, which factor should be ruled out?

• A. Vascular disease
• B. Endocrine disorders
• C. Psychological factors
• D. Neurological disorders

Answer: (C)

The main idea is that erectile dysfunction is usually multifactorial, and psychological factors are a common, modifiable contributor that clinicians actively assess during evaluation. Psychological issues such as performance anxiety, stress, depression, and relationship problems can significantly impair arousal and the ability to maintain an erection even when the vascular, hormonal, and neurological systems are functioning normally. Because these psychogenic factors can masquerade as or exacerbate organic problems, it’s important to evaluate and rule them in or out as a contributing cause. When psychological factors are identified as a key driver, management shifts toward psychotherapy, sex therapy, and addressing emotional or relational stress, while still considering medical treatments for any underlying organic conditions. This approach helps tailor treatment to the patient’s actual needs and can prevent unnecessary invasive testing if a psychogenic component is primary.