VALIDATION OF A PSYCHOPHYSIOLOGICAL WAKING ERECTILE ASSESSMENT (WEA) FOR THE DIAGNOSIS OF MALE ERECTILE DISORDER

Objective. The aim of the present study was to evaluate a psychophysiological waking erectile assessment (WEA). WEA was designed to elicit penile responses using visual and vibrotactile stimuli and cognitive tasks (distraction and monitoring of erections). Methods. One hundred consecutive patients with erectile dysfunction and a control group of 50 sexually functional males were examined. Clinical decision analysis, including a receiver operating characteristic (ROC) analysis, was used to determine the accuracy of WEA in predicting independent diagnostic classifications. Results. Fifty percent of the patients were independently diagnosed as having pure psychogenic impotence. In 45 percent of the patients an organic factor was found. Discrimination was best in three (out of 7) WEA conditions in which film was combined with vibration. This combination of conditions resulted in a test sensitivity of 81 percent, and predictive values positive (the probability of ''no organic involvement'' given a penile response greater than 1 2 mm) ranging from 66 to 95 percent. About one third of the patients with pure psychogenic erectile dysfunction had an average response of more than 30 mm to the three conditions combining vibration and film. None of the patients with organic involvement exceeded this 30 mm criterion. Thus, the predictive value positive reached its maximum of 100 percent. Conclusions. The results suggest that WEA is an appropriate initial screening procedure, and that it is of particular value in the detection of psychogenic cases.