Characteristics of Erectile Dysfunction as a Function of Medical Care System Entry Point R. TAYLOR SEGRAVES, MD, PHD, HARRY W. SCHOENBERG, MD, CHRISTOPHER K. ZARINS, MD, PAUL CAMIC, MA, AND JENNIFER KNOPF, MA The scientific literature on the treatment of penile erectile dysfunction contains numerous contradictory reports on the relative frequency of organic causes of impotence and the treatment results of behavioral sex therapy. One explanation for these contradictory findings is the hypothesis that different investigators are studying different subsamples of the symptomatic population. This study investigated differences in characteristics of men who initially con- sulted a urologist with a complaint of impotence versus those who self-referred themselves to a sexual dysfunction clinic. Self-referred sexual dysfunction patients were more often white, more often had psychogenic etiologies to their difficulties, were more often of higher socioeconomic class, and had a much better response to psychological interventions. This study suggests that future studies concerning the etiology and treatment of impotence need to specify population characteristics such as referral source and screening criteria. It may be necessary to develop alternative treatment techniques for men who present to nonpsychiatric sources for help with psychogenic impotence. In the late 1950s and early 1960s behav- ior therapists (1,2) began reporting prom- ising results using brief symptom- oriented treatment approaches to treat sexual dysfunction. Symptom-oriented interventions gained wider acceptance in the medical community with the publica- tion of Human SexuaJ Inadequacy (3) in 1970. This publication has had consider- able heuristic impact. Numerous other medical centers have attempted to repli- cate Masters and Johnson's findings (4,5), numerous controlled studies of behavioral sex therapy have been reported (6,7), and there has been a renewed interest in dif- From the tlepartments of Psychiatry, Surgery, and the Sexual Dysfunction Clinic, University of Chicago Medical Center, Chicago, Illinois. Address requests for reprints to: Dr. R. Taylor Segraves, Department of Psychiatry, University of Chicago Medical School, 950 East 59th Street, Chicago, IL 60637. Received for publication September 11, 1980; re- vision received January 5, 1981. ferentiating psychogenic from organic sexual dysfunction (8,9). Results of attempts to replicate Masters and Johnson's findings have varied con- siderably from center to center. Most au- thors have reported lower symptom rever- sal rates than those reported by Masters and Johnson (10). Several others (11) have suggested that the variability in reported treatment outcomes from various centers may be related to differences in patient populations treated. In particular, it ap- pears that clinical series employing strin- gent screening procedures have reported higher success rates than those employing less stringent screening criteria. The hypothesis of differential sampling of the symptomatic population by dif- ferent clinical centers may be especially important in understanding the contradic- tory research literature concerning the treatment of male excitement phase dis- orders. Although several investigators have replicated Masters and Johnson's Psychosomatic Medicine Vol. 43, No. 3 (June 1981) Copyright © 1961 by the American Psychosomatic Society, Inc. Published by Elsevier North Holland, Inc 52 Vanderbilt Aye , New York, NY 10017 227 0033-3174/81K)3022708$02 50