Abstract
The age-old problem of psychogenic impotence is now understood to comprise a mixture of cases involving desire and arousal difficulties. This paper presents a psychodynamic model for conceptualizing the pathogenesis of arousal problems that involves the resonation of forces that derive from 3 spheres of causality: (1) performance anxiety, (2) antecedent life changes, and (3) developmental vulnerabilities. The most prevalent forms of psychogenic impotence occur after a prolonged period of secure potency and come about after contributions from each sphere. Lifelong psychogenic impotence is produced primarily by developmental vulnerabilities, although performance anxiety often predominates. Focused psychotherapy based on these concepts of pathogenesis is discussed.
