Introduction. Sigmund Freud was one of the most influential thinkers and theorists of the 20th century. His groundbreaking work laid the foundation to many concepts and theories relevant to modern sexual medicine. Aim. To evaluate Freud's approaches to the understanding of male sexual dysfunction both in their historical context and with respect to their significance for contemporary research and therapy of sexual problems. Methods. After a brief biographical sketch, two of Freud's writings, the widely acclaimed "Three Essays on the Theory of Sexuality" from 1905, and a short article entitled "The Most Prevalent Form of Degradation in Erotic Life" from 1912, were analyzed, especially for their relevance to present treatment concepts of male sexual dysfunction. Results. In Freud's clinical practice "psychical impotence" was a highly prevalent complaint. In his view, this dysfunction was caused by an inhibition due to an unresolved neurotic fixation leading to an arrest of the libidinal development. The result is a splitting of the tender and the sensual dimension of sexuality, most notably in the so-called madonna-whore complex. The degree of this dissociation (total or partial) determines the severity of the ensuing sexual dysfunction. In Freud's rather pessimistic view, the erotic life of civilized people tends to be characterized by some degree of this condition. Conclusions. While some of Freud's theories are obsolete today, many parts of his work appear to be astonishingly modern, even in the light of current neurobiological research and recent models of sexual dysfunction. Above all, Freud was an extremely gifted observer of human behavior who shows us that in many cases, sexual dysfunctions are no isolated phenomena, but have their roots in biographically based intrapsychic or interpersonal conflicts. Hartmann U. Sigmund freud and his impact on our understanding of male sexual dysfunction. J Sex Med 2009;6:2332-2339.
