History A careful history, including a drug history, will usually differentiate organic from psychogenic impotence. Organic impotence generally has a gradual, insidious onset with progressive worsening until no erection is obtained. Later, there is a complete inability to penetrate. Organic impotence is evident consistently in all situations, whether during attempted intercourse with his regular or another partner, masturbation or in response to erotic stimuli. Nocturnal erections are markedly diminished and this manifests as a loss of erections on waking.
Psychogenic impotence is more likely to have an abrupt onset.
The impotence is often inconsistent, occurring only in certain situations. Nevertheless, organic impotence usually invokes a secondary psychological overlay which may complicate evaluation of the aetiology. This underlines the need for a careful, unhurried approach and empathy during history taking. Androgen deficiency causes more loss of libido than erectile dysfunction. It is unusual for men complaining of impotence to have androgen deficiency as a cause of their sexual dysfunction.