Organic vs. psychogenic? The manichean diagnosis in sexual medicine

Introduction. The Manichean diagnosis, psychogenic or organic, is the first and most frequent diagnostic scope managing sexual disorders. The aim of this Controversy is to discuss if this philosophy is still useful both in the conceptual and clinical perspective. Methods.: Five scientists (an endocrinologist, two psychologist, and two urologists) with expertise in the area of psychosexology and sexual medicine were asked to contribute with their opinions. Main Outcome Measure.: Expert opinion supported by the critical review of the currently available literature. Result.: Expert # 1, who is Controversy's section Editor, suggests that the term psychogenic is redundant, because all sexual dysfunctions involve the mind and the relationship with (at least) one partner. Furthermore, he is strongly against the exclusion diagnosis, in agreement with the Expert # 5. The idea that the psychogenic etiology is always present is also sustained with good arguments by the Expert # 2. On the other hand, the two Experts # 3 and 4 argue that a pharmacological treatment such as type 5 phosphodiesterase inhibitors or dapoxetine work in both organic and psychogenic conditions and that the attempt to perform a diagnostic effort is frequently useless. Last but not least, the Expert # 5 concludes that the mind-body dualism is to be considered obsolete and unhelpful in a modern approach to the patient with a sexual dysfunction. Conclusions.: The reader of the Journal will judge if there is still a room for the Manichean diagnosis of different sexual dysfunctions or if it is time to completely change our perspective on this essential aspect of clinical sexual medicine.