(783) From the Manichean Dichotomy, Through the Biopsychosocial Model, to Systems Sexology, the Final Evolution of Sexual Medicine

Abstract

Abstract Introduction Over time, the conceptualisation of erectile dysfunction (ED), and approaches to its treatment, have changed considerably. However, there remains an important need to challenge the Manichean dichotomy of viewing ED as either psychogenic (arising from the mind) or organic/biological in nature. Objective To know the evolution of sexual medicine throughout the past centuries, highlighting key paradigm shifts in understanding of sexual dysfunctions, including ED. Methods Literature search was conducted in PubMed, Medline, and Cochrane Systematic Reviews. Date restrictions were not considered. Consensus statements, expert opinion, and all review articles were included. Results Through analysis of the biopsychosocial model, the Manichean or dichotomous approach to diagnosis, and the modern systems sexology approach, we argue that the term psychogenic is not only redundant in modern practice but is an affront to the progress made in the field of sexual medicine, potentially harming patients. A systems sexology approach is needed to integrate an understanding of the mind, the body, experiences, and society to understand how sexual dysfunctions such as ED may be effectively managed (Figure 1). Figure 1. Diagram of systems sexology as applied to erectile dysfunction evaluation. Pathogenesis of erectile dysfunction in the light of systems sexology. Note: The four systems (mind, experience, society, and body) deeply influence each other, having the wrong lifestyles as a common pathogenetic mechanism and acute, subacute, and chronic inflammation as a common mechanism of action. Abbreviations: CDs, communicable diseases; NCDs, non-communicable diseases. Conclusions The complexity of human sexuality, its health, its symptoms and diseases has been and still is a challenge for research and for clinical practice. After the two steps in the XIX-XX centuries of the psychodynamic-cognitive-behavioural therapies and then of the Viagra Revolution, both psychosexology and sexual medicine did not modify their reciprocal posture nor the risk to be prone to the original sins of psychological and medical reductionisms. Disclosure Yes, this is sponsored by industry/sponsor: Viatris Inc. Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Prof Jannini is a consultant of BAYER, IBSA, MENARINI, VIATRIS

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