Impuissance sexuelle iatrogène et responsabilité médicale

Resume

Le fondement de la responsabilité médicale est basé sur le principe de la faute, du dommage subi et de l’établissement du lien de causalité entre la faute et le dommage. Les auteurs rapportent un cas clinique observé dans le cadre d’une expertise médicale d’un accident iatrogène (priapisme) secondaire au traitement d’une impuissance psychogène par injection de papavérine en intracaverneux. Ils analysent les fondements de l’éventuel engagement de la responsabilité médicale du médecin traitant. partant de ce cas, les auteurs insistent sur la nécessité d’une évaluation psychologique préalable à tout traitement médicamenteux d’une impuissance psychogène.

Abstract

Medical responsibility means that the Doctor must assume his acts. It enables not only to repair prejudices met but also discourage prejudiciable acts to society by sanctioning them. Its founding is based on the principle of error, of the damage caused and the establishing of a cause link between error and damage. The authors report a clinical case observed during a medical expertise of an iatrogenic accident (priapism) secondary to the treatment of a psychogenic impotence with papaverine injection in intracavernous. It’s a 27 year old patient, single, teacher, without pathological antecedents, who, after a psycho-affective shock (break with his girl-friend), showed a diminished sewal desire and erectile power. These complaints led him to consult an urologist, who prescribed a hormonal check-up and a medical treatment based on Yohimbine^* for two weeks. Seeing no improvement of his state, he consulted another urologist who gave him an intracavernous Papaverine chlorydrate injection (40 mg). The immediate main consequenœs were a priapism necessitating a surgical intervention (caverno-spongious anastomosis), practised one day after the injection. Following the intervention, the patient complains of a persistant impotenœ, which led him to sue his Doctor for a professional error having led to a permanent sexual prejudice. The error retained against the Doctor consists in a bad control of his patient, which led to delay in taking the latter in charge, a classical complication resulting from the treatment prescribed. Because of the existence of an error, a damage caused and a cause link, the responsibility of the Doctor is in question. From this case, the authors insist on the necessity of a psychologic evaluation prior to every medicinal treatment of a psychogenic impotence.