Back to Stir It Up: Erectile Dysfunction in an Evolutionary, Developmental, and Clinical Perspective

Abstract

In this review, we analyze erectile dysfunction (ED) in the context of sexual selection. We highlight that ED is a specific human male characteristic linked to the loss of the baculum or penile bone and results from a range of physical and psychological factors. We discuss evolutionary interpretations that consider dysfunctional penile erection as an honest signal of a low-quality male. We further emphasize the importance of considering psychosocial context and early attachment dynamics for understanding the etiology of some types of ED. Finally, we suggest that the integration of developmental factors for understanding the emergence of this sexual disorder is instrumental for the calibration of more effective therapies.

Acknowledgments

We thank David Puts, Kevin Rosenfield, and Talia Shirazi for their helpful comments on an earlier draft of this manuscript.

Notes

Male quality: In line with Darwin’s model of sexual selection, males are variable with respect to phenotypic characteristics, which are indicators of genetic quality. In evolutionary context, the term quality refers to general hereditary characteristics of lifetime reproductive success.