Self-generated distraction in erectile dysfunction: The role of attentional processes

The present paper reviews the available literature on relevant maintaining factors in sexual dysfunction, focusing on definitions of sexual performance anxiety. Empirical studies have defined anxiety as elevated sympathetic arousal or as a cognitive state involving selective attention. These are reviewed, with particular reference to observed differences in patterns of response with sexually functional and dysfunctional men. Overall, investigations which have operationalized anxiety as increased autonomic activity appear to produce inconsistent effects on tumescence, while studies examining various attentional states indicate that cognitive interference may be more salient in diminishing arousal. Important response dimensions in sexual dysfunction may include self-generated distracting thoughts and diminished awareness of affective states, which reduce physiological arousal presumably through distraction. Implications for sex therapy are discussed, including future directions for conceptualizing the influence of sexual desire on treatment outcome.