The Sexual Response Cycle and Erectile Dysfunction

The sexual response cycle describes the sequence of psychophysiological events that make up sexual activity. Knowing the phases helps place erectile dysfunction (ED) in context and clarifies what a clinician and patient are trying to treat.

Phases of the sexual response cycle

Masters and Johnson described four stages:

1. Desire — the wish or interest in sexual activity.
2. Arousal — the body prepares for sexual activity. In men this includes achieving and maintaining an erection.
3. Orgasm — climax, with release of sexual tension.
4. Resolution — return to the resting state after orgasm.

ED is a problem of the arousal phase: a consistent or intermittent inability to achieve or sustain an erection sufficient for satisfactory sexual activity. Difficulty at arousal can also reduce desire and make orgasm harder to reach. For a fuller clinical overview, see understanding erectile dysfunction: causes, diagnosis, and treatment.

Erectile dysfunction in context

ED is a medical condition with physical and psychological components. It can affect confidence and intimate relationships. Treatment decisions should reflect both the medical findings and the patient’s priorities.

Shared decision-making

Shared decision-making is a partnership between patient and clinician. Together they review risks, benefits, and desired outcomes of each option. In practice that means:

1. Autonomy — the patient decides about his own body and health.
2. Full information — unless a treatment is medically inadvisable, he should hear the available options.
3. Flexible choice — many men start with the least invasive option; others prefer a different route, or no treatment. All of those choices are valid when they are informed.
4. Clinician as guide — the clinician helps the patient (and, when appropriate, his partner) understand benefits and risks of each strategy.

The 2018 AUA Erectile Dysfunction Guideline puts shared decision-making at the center of care. See shared decision-making in erectile dysfunction care.

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