Controversies in Sexual Medicine: Organic vs. Psychogenic? The Manichean Diagnosis in Sexual Medicine
Abstract
INTRODUCTION: The Manichean diagnosis, psychogenic or organic, is the first and most frequent diagnostic scope managing sexual disorders. The aim of this Controversy is to discuss if this philosophy is still useful both in the conceptual and clinical perspective. METHODS: Five scientists (an endocrinologist, two psychologist, and two urologists) with expertise in the area of psychosexology and sexual medicine were asked to contribute with their opinions. MAIN OUTCOME MEASURE: Expert opinion supported by the critical review of the currently available literature. RESULT: Expert # 1, who is Controversy's section Editor, suggests that the term psychogenic is redundant, because all sexual dysfunctions involve the mind and the relationship with (at least) one partner. Furthermore, he is strongly against the exclusion diagnosis, in agreement with the Expert # 5. The idea that the psychogenic etiology is always present is also sustained with good arguments by the Expert # 2. On the other hand, the two Experts # 3 and 4 argue that a pharmacological treatment such as type 5 phosphodiesterase inhibitors or dapoxetine work in both organic and psychogenic conditions and that the attempt to perform a diagnostic effort is frequently useless. Last but not least, the Expert # 5 concludes that the mind-body dualism is to be considered obsolete and unhelpful in a modern approach to the patient with a sexual dysfunction. CONCLUSIONS: The reader of the Journal will judge if there is still a room for the Manichean diagnosis of different sexual dysfunctions or if it is time to completely change our perspective on this essential aspect of clinical sexual medicine.
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ED represents a spectrum with various degrees of psychological and biological involvement.
“Although underlying etiology is important to ensure appropriate management, fragmentation must be averted because ED represents a spectrum with various degrees of psychological and biological involvement.73”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [73]
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“However, this dichotomization has been discouraged, as it is hard to fully separate organic, and psychogenic conditions.(40) In practical terms, it is likely that most cases involve both possible etiologies, in a way that makes it difficult to consider any case as being exclusively organic or psychogenic.”
Stern, N., Bajic, P., Campbell, J. D., Capogrosso, P., Domes, T., Miranda, E., Mulhall, J. P., Nascimento, B., Pignanelli, M., Pastuszak, A. W., et al. (2025) · Sexual Medicine Reviews · doi:10.1093/sxmrev/qeaf035 · Cited by 17 · see citing works
Chen, G., Chen, J., Yang, B., Yu, W., Chen, Y., & Dai, Y. (2018) · Andrologia · doi:10.1111/and.13160 · Cited by 16 · see citing works
Burgio, G., Giammusso, B., Calogero, A. E., Mollaioli, D., Condorelli, R. A., Jannini, E. A., & Vignera, S. L. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8101679 · Cited by 16 · see citing works
A Benefit-Risk Assessment of Dapoxetine in the Treatment of Premature Ejaculation
Hutchinson, K., Cruickshank, K., & Wylie, K. R. (2012) · Drug Safety · doi:10.2165/11598150-000000000-00000 · Cited by 16 · see citing works
“therapy’ for the treatment of PE by utilizing both behavioural and pharmacological treatments.([10,41])”
MethodA Practical Approach to Premature Ejaculation
Jannini, E. A., & Porst, H. (2011) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2011.02456.x · Cited by 15 · see citing works
Bolat, D., Kocabaş, G. Ü., Günlüsoy, B., Aydoğdu, Ö., & Aydın, M. E. (2017) · International Journal of Impotence Research · doi:10.1038/ijir.2017.3 · Cited by 15 · see citing works
Lack of Sexual Privacy Affects Psychological and Marital Domains of Male Sexual Dysfunction
Boddi, V., Fisher, A. D., Maseroli, E., Rastrelli, G., Corona, G., Jannini, E. A., Ricca, V., Mannucci, E., & Maggi, M. (2013) · The Journal of Sexual Medicine · doi:10.1111/jsm.12382 · Cited by 14 · see citing works
Haptic and Somesthetic Communication in Sexual Medicine
Moscatelli, A., Nimbi, F. M., Ciotti, S., & Jannini, E. A. (2020) · Sexual Medicine Reviews · doi:10.1016/j.sxmr.2020.02.003 · Cited by 14 · see citing works
Jannini, E. A., & Hassan, T. A. (2025) · Trends in andrology and sexual medicine · doi:10.1007/978-3-031-98580-5_7 · Cited by 13 · see citing works
Pan, J., Zheng, Z., Wang, W., Hu, D., Yao, R., Chen, Y., Ding, H., Zhong, J., Hao, Z., & Liao, G. (2024) · BMC Infectious Diseases · doi:10.1186/s12879-024-09611-7 · Cited by 9 · see citing works
“…wide-spread fear of mKTRs and the global population towards COVID-19, along with the uncertainty of the future, financial and economic losses, and reduced social sup - port during lockdown, have exacerbated psychological distress, depression, and anxiety among individuals in the population [30].”
BackgroundSansone, A., Guida, E., Dolci, S., Frangione, V., Asso, A., Bellia, G., & Jannini, E. A. (2025) · Basic and Clinical Andrology · doi:10.1186/s12610-024-00245-y · Cited by 8 · see citing works
“In these regards, it would conceptually be wrong to define ED as “organic vs. psychogenic” [46], as, in fact, all sexual dysfunctions can lead to psychological or relational issues, and there is no way to prove that some forms of ED are purely mind-generated (the literal translation of psychogenic)…”
Huang, Y.-P., Zhang, Y.-D., Gao, Y., Yao, F.-J., Wang, Y., Chen, X., Ye, Y., Ouyang, B., Chen, S. X., Yuan, X.-X., et al. (2012) · International Journal of Impotence Research · doi:10.1038/ijir.2012.26 · Cited by 8 · see citing works
The pharmacist's role in improving the treatment of erectile dysfunction and its underlying causes
Taylor, D. G., Giuliano, F., Hackett, G. I., DeSantis, E. R. H., Kirby, M. G., Kloner, R. A., Maguire, T., Stecher, V. J., & Goggin, P. (2018) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2018.07.014 · Cited by 7 · see citing works
The role of acupuncture in treating premature ejaculation and its probable neurobiological mechanism
Wang, A., Wang, H., Ma, D., Chang, H., Zhao, Z., Luo, D., & Wang, F. (2024) · Basic and Clinical Andrology · doi:10.1186/s12610-024-00239-w · Cited by 6 · see citing works
Erectile Dysfunction in Young Adults: A Narrative Review
Safa, A. M., & Waked, C. (2025) · Cureus · doi:10.7759/cureus.89918 · Cited by 6 · see citing works
“Although psychogenic ED is often considered the primary cause in younger individuals, a thorough evaluation of organic factors should not be overlooked, as ED is now recognized as a multifactorial condition [15,16].”
Toksöz, S., Erdem, R., Peşkircioğlu, Ç. L., & Keskin, U. (2013) · Spinal Cord · doi:10.1038/sc.2013.61 · Cited by 6 · see citing works
The association between acquired premature ejaculation and metabolic syndrome in young Chinese men
Lu, Y., Liang, Z. C., Tian, J. H., Li, Z., Song, Y., Wang, X., Liu, K., Zhou, K., Yang, Y., & Liu, X. (2020) · Andrologia · doi:10.1111/and.13787 · Cited by 8 · see citing works
Iuliano, S., Seminara, G., Zagari, M. C., Luigi, L. D., & Aversa, A. (2023) · Sexes · doi:10.3390/sexes4010006 · Cited by 5 · see citing works
“On the other hand, it is now clear that it is hard to fully separate organic and psychogenic conditions, which in most cases coexist and contribute to the pathogenesis of ED [18].”
BackgroundXiang, Z., Huang, Y., Xu, Y., Liu, X., Huang, X.-F., Liu, T., Yang, Z., Jiang, L., Chen, Y., & Chen, J. (2023) · Andrology · doi:10.1111/andr.13442 · Cited by 5 · see citing works
Hoai, B. N., Thắng, N. C., Pham, Q. M., Long, H., Sansone, A., & Jannini, E. A. (2023) · Andrology · doi:10.1111/andr.13516 · Cited by 5 · see citing works
“20,21 Several studies considered IELT as an “objective criterion” for evaluating PE.”
BackgroundJenkins, L. C., Hall, M., Deveci, S., Guhring, P., Parker, M., Nelson, C. J., & Mulhall, J. P. (2019) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2019.07.013 · Cited by 5 · see citing works
“[2] Most patients with ED, regardless of the etiology, suffer from fear, anxiety, worry, depression, and distress because of their erectile impairment.[3]”
BackgroundWang, M., Dai, Y., Jiang, H., Sansone, A., Jannini, E. A., & Zhang, X. (2022) · The Aging Male · doi:10.1080/13685538.2022.2121815 · Cited by 4 · see citing works
From Diagnosis to Treatment: The Office Management of Premature Ejaculation
Jannini, E. A., & Lenzi, A. (2012) · Springer eBooks · doi:10.1007/978-88-470-2646-9_25 · Cited by 4 · see citing works
“Note that the classification of PE does not necessarily imply an etiological diagnosis: a situational PE is not necessarily psychogenic in origin; a lifelong PE is not necessarily organic in nature [4].”
BackgroundInfluentialMollaioli, D., Sansone, A., Jannini, T. B., Hoai, B. N., Nguyen, T. C., Pham, Q. M., Ciocca, G., & Jannini, E. A. (2025) · The Aging Male · doi:10.1080/13685538.2025.2509006 · Cited by 3 · see citing works
Coşkunsever, D., Olukman, M., Jannini, E. A., Sansone, A., & Varrassi, G. (2023) · Cureus · doi:10.7759/cureus.48770 · Cited by 3 · see citing works
Antioxidants in Male Sexual Dysfunctions
Sansone, A., Jannini, E. A., & Romanelli, F. (2016) · Trends in andrology and sexual medicine · doi:10.1007/978-3-319-41749-3_6 · Cited by 3 · see citing works
Comprehensive History of the International Society for Sexual Medicine–Journals and Communication
Lewis, R. W. (2021) · Sexual Medicine Reviews · doi:10.1016/j.sxmr.2021.04.002 · Cited by 3 · see citing works
Pathophysiology of Acquired Premature Ejaculation
Jannini, E. A., & Lenzi, A. (2012) · Springer eBooks · doi:10.1007/978-88-470-2646-9_7 · Cited by 3 · see citing works
Avanafil: The Second-Generation Treatment of Erectile Dysfunction
Corona, G., Maggi, M., & Jannini, E. A. (2016) · European Medical Journal · doi:10.33590/emj/10314434 · Cited by 3 · see citing works
Diffusion tensor imaging: A new valuable method for understanding male sexual functioning
Corona, G., & Jannini, E. A. (2020) · Andrology · doi:10.1111/andr.12768 · Cited by 3 · see citing works
Carlomagno, F., Tenuta, M., Sansone, A., Rastrelli, G., Sciarra, F., Cangiano, B., Isidori, A. M., Gianfrilli, D., & Krausz, C. G. (2026) · Human Reproduction Update · doi:10.1093/humupd/dmag010 · Cited by 2 · see citing works
“Among these, hypogonadism plays a central role, as testosterone is essential for maintaining libido, erectile capacity, and overall sexual function (Papadimas et al. , 2002; Jannini et al. , 2010; Bordbar et al. , 2019).”
Diabetic Neuropathy: Clinical Management—Genitourinary Dysfunction in Diabetes
Spallone, V., Agrò, E. F., Centello, R., Lecis, C., Orecchia, L., & Isidori, A. M. (2023) · Contemporary diabetes · doi:10.1007/978-3-031-15613-7_28 · Cited by 2 · see citing works
The Elephant in the Bedroom: Sexual Functioning in Military Populations
Wilcox, S. L., Schuyler, A. C., & Hassan, A. M. (2015) · 2015 APHA Annual Meeting & Expo (Oct. 31 - Nov. 4, 2015) · doi:10.13140/rg.2.1.4474.0648 · Cited by 2 · see citing works
A Multidisciplinary Approach to Sexual Behavior Profiles: The SEX360 Model
García-Cruz, E., Fierro, J. M. M., Marre, D., González, M., Godoy, M. F. P., Sánchez, C., Suso‐Ribera, C., Omeñaca, A. T., & Alcaraz, A. (2017) · Sexuality & Culture · doi:10.1007/s12119-017-9448-4 · Cited by 2 · see citing works
“More than one decade after the work carried out by Masters and Johnson, the development of echo-Doppler flowmetry and neurophysiological procedures helped explain many sexual disorders physiologically, launching a new stage labeled by some authors as ‘‘medical reductionism’’ (Jannini et al. 2010).”
BackgroundXiu, X., Zhang, R., Lin, J., & Song, L. (2024) · International Urology and Nephrology · doi:10.1007/s11255-024-04045-1 · Cited by 1 · see citing works
“MEP denotes the highest achievable level of erectile hardness and duration in the absence or significant reduction of specific environmental stressors, such as the sexual partner's attitude and the act of sexual intercourse [23, 31].”
Effects of double neonatal stress on female rat sexual behaviour
Ferraz, M. R., Guimarães, J. S., Monteiro, V. U., Santos, L. N., Silva, J. S. C. E., Barbosa, E. D. S., & da Silva, S. D. S. (2024) · Physiology & Behavior · doi:10.1016/j.physbeh.2024.114692 · Cited by 1 · see citing works
Gebrie, E., Chane, E., Mengistie, B. A., Kibralew, G., Worku, H., Mulugeta, B., & Zayede, A. (2026) · Sexual Medicine Reviews · doi:10.1093/sxmrev/qeag046 · Cited by 1 · see citing works
Jannini, E. A., & Siracusano, A. (2018) · Trends in andrology and sexual medicine · doi:10.1007/978-3-319-68306-5_1 · Cited by 1 · see citing works
Sexual Disorders in Adolescents and Young Adults
Ciocca, G., Limoncin, E., Sansone, A., Zauri, S., Colonnello, E., Simeoli, C., Siracusano, A., Lorenzo, G. D., Balercia, G., & Jannini, E. A. (2021) · Trends in andrology and sexual medicine · doi:10.1007/978-3-030-80015-4_12 · Cited by 1 · see citing works
Organic or psychological? It does matter!
Glina, F. R., & Glina, S. (2022) · International braz j urol · doi:10.1590/s1677-5538.ibju.2022.99.11 · Cited by 1 · see citing works
“Failure to identify symptoms such as anxiety and depression, which are recognized causes of ED (4), can make the patient’s treatment more difficult and lead to inappropriate conduct, as well as ineffective results.”
BackgroundInfluentialDisorders of Erection, Cohabitation, and Ejaculation
Soave, A., & Kliesch, S. (2023) · Springer eBooks · doi:10.1007/978-3-031-31574-9_30 · Cited by 1 · see citing works
Terapia cognitivo-comportamental em grupo no tratamento de disfunções sexuais femininas
Lerner, T. (2012) · doi:10.11606/d.5.2012.tde-24052012-160753 · Cited by 1 · see citing works
Comment on: Hard-flaccid syndrome: a report of two cases
Colonnello, E., & Jannini, E. A. (2025) · International Journal of Impotence Research · doi:10.1038/s41443-025-01093-8 · Cited by 1 · see citing works
“…dichotomy, which reduces sexual dysfunction to either psychogenic or organic origins [7] — a simplistic and potentially harmful perspective [8] — BPS already rejects dualism in favour of complexity and recognises that sexual symptoms, such as those presented in HFS, are rarely attributable…”
Erectile dysfunction in cardiovascular risk population
Ettala, O. O. (2015) · UTUPub (University of Turku)
Jiann, B. (2015) · The Journal of Sexual Medicine · doi:10.1111/jsm.12992
Holman, H. T., & Armstrong, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-26091-4_9
Singh, N. R., & Sandhu, I. M. S. (2019) · AMEI's Current Trends in Diagnosis & Treatment · doi:10.5005/jp-journals-10055-0074
Psikolojik Yönleriyle Erektil Disfonksiyon: Nedenler - Belirtiler - Çözümler
Demirel, Y. (2021) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.6
Störungen der Erektion, Kohabitation und Ejakulation
Soave, A., & Kliesch, S. (2022) · Springer Reference Medizin · doi:10.1007/978-3-662-61904-9_30-1
Neurogenic control of sexual function
Appenzeller, O., Lamotte, G. J., & Coon, E. A. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-95584-3.00001-4
Störungen der Erektion, Kohabitation und Ejakulation
Soave, A., & Kliesch, S. (2023) · Springer Reference Medizin · doi:10.1007/978-3-662-61901-8_30
Khorram, A. A., Razzaghi, Z., Rahnama, H., & Allameh, F. (2024) · Nephro-Urology Monthly · doi:10.5812/numonthly-146347
“The causes of ED can range from vasculogenic, neurogenic, anatomical, hormonal, pharmaceutical, to psychological factors (2).”
BackgroundPang, T., Limbrick, H., & Eberhardt, J. (2024) · Journal of Public Health · doi:10.1007/s10389-024-02375-z
“While there are biopsychological factors that precipitate the onset of sexual dysfunction, the paradigm of organic and psychogenic distinction is becoming obsolete and deemed as reductionist (Jannini et al. 2010), as it is now known that the mind and body do not function independently (Bishop 1994).”
Dong, H., Wang, X., Wang, R., Fang, J., & Pan, T. (2026) · Sensors and Actuators A Physical · doi:10.1016/j.sna.2026.117620
Sansone, A., Mantegazza, R., Vignesh, S. O., & Jannini, E. A. (2026) · The Aging Male · doi:10.1080/13685538.2026.2652123
- Authors
- Jannini, E. A., McCabe, M. P., Salonia, A., Montorsi, F., & Sachs, B. D.
- Affiliations
- University of L'Aquila (IT)
- Deakin University (AU)
- Vita-Salute San Raffaele University (IT)
- University of Connecticut (US)
- Corresponding author
- Jannini, Emmanuele A.
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-05-01
- Volume
- 7
- Issue
- 5
- Pages
- 1726-1733
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W2126582731
- Cited by
- 99
- References
- 50
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 5 · 2021: 8 · 2020: 7 · 2019: 9 · 2018: 7 · 2017: 7 · 2016: 7 · 2015: 5 · 2014: 2 · 2013: 5 · 2012: 6
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- sexual dysfunction, psychogenic etiology, organic etiology, mind-body dualism, diagnosis of exclusion, phosphodiesterase inhibitors, dapoxetine, sexual medicine, expert opinion
- MeSH terms
- Combined Modality Therapy, Diagnosis, Differential, Female, Humans, Erectile Dysfunction, Male, Sexual Dysfunction, Physiological, Cognitive Behavioral Therapy, Treatment Outcome, Sexual Dysfunctions, Psychological
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