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Potential for Long-Term Benefit of Cognitive Behavioral Therapy as an Adjunct Treatment for Men with Erectile Dysfunction
Abstract
Introduction:
Psychosexual counseling may enhance sexual performance outcomes in men with erectile dysfunction (ED) treated with a phosphodiesterase type 5 (PDE5) inhibitor.
Aim:
To determine the potential long-term effects of cognitive behavioral therapy (CBT) on Pakistani men with ED who had undergone treatment with a PDE5 inhibitor (PDE5i).
Methods:
In a 15-18-month follow-up, we reassessed a subsample of 20 men who had been treated with either PDE5is (monotherapy group) or CBT + PDE5i (combined group) on 2 dimensions: sexual functioning and mental health functioning.
Main outcome measure:
International Index of Erectile Function was used to assess sexual function, and 2 Mental Health Inventory subscales were used to assess anxiety and depression. A brief semi-structured interview assessed men's current sexual status and evaluation of their CBT experience.
Results:
Men in the combined group continued to show improvement on erectile function and several other sexual parameters, whereas men in the monotherapy group showed either no further improvement or a decrement in sexual response parameters. The results did not appear to be related to changes in relationship satisfaction or mental health indices.
Clinical implications:
Adjunctive CBT shows long-term benefits in men with ED treated with a PDE5i.
Strength & limitations:
Effect sizes were strong, overcoming the small sample size, but attrition may affect the generalizability of the findings.
Conclusion:
In the first long-term follow-up study of its kind, CBT proved an effective and supportive adjunctive treatment for Pakistani men with ED taking a PDE5i, with benefits extending long after the end of treatment. Khan S, Amjad A, Rowland D. Potential for Long-Term Benefit of Cognitive Behavioral Therapy as an Adjunct Treatment for Men with Erectile Dysfunction. J Sex Med 2019;16:300-306.
... The result is cognitive behavior sex therapy (CBST), a non medical psychotherapeutic approach to be used in conjunction with pharmacotherapy in the management of NOED. 21,22 The CBST consists of several components including psychosexual education, cognitive restructuring of sexuality related attitudes, challenging automatic thoughts through Socratic dialogue and other techniques. Further, the therapy works by instructing the client new sexual communication skills, new meanings of one's sexuality, and other specific techniques for improving male sexual function and overcoming psychological barriers in the way of sexual pleasure and functioning. ...
... Such cohort of men reported the lasting effects of integrated treatment at 15 − 18 months follow up later. 22 At follow up, the improved effects in domains like erectile function, intercourse satisfaction, and sexual desire remained stable. In another study, the men who received group sex therapy in combination with SC improved erectile function considerably as compared to men who were taking SC only and were less likely to drop out. ...
... Previously, the new treatment approach based on sex therapy and CBT principles had been found significantly effective in improving IIEF-5 scores both as a single treatment 23 and in integration with SC in Pakistani men. [20][21][22]24 The CBST is a treatment of choice for NOED when administered either as a single treatment or in combination with PDE5i. 21−23 The current study found CBST significantly effective in improving IIEF-5 scores, and in reduction of depression scores. ...
Introduction
The integrated treatment combining phosphodiesterase-type 5 inhibitors (PDE5i) and Cognitive Behavior Sex Therapy (CBST) has been shown to yield promising results in the treatment of Non Organic Erectile Dysfunction (NOED) in young men.
Aim
The current study aimed to establish the efficacy of integrated treatment combining Sildenafil Citrate (SC) 50mg and CBST as a treatment of choice in young Pakistani men with NOED.
Methods
One hundred thirty-seven young men were recruited to participate in the study out of 164 men referred from sexual health clinics in Pakistan. They were randomized sequentially into 4 treatment groups namely SC = 35, CBST = 34, integrated treatment = 35, and placebo = 33. 7, 4, 6, and 4 men were dropped out of each treatment group respectively. The data of 116 men were analyzed. The on demand SC 50 mg, twice weekly 50 minutes sessions and home assignments, a combination of SC and 50 minutes sessions, and placebo were administered to firsst, second, third, and fourth group respectively for a period of 12 weeks. The follow-up assessment was done after 12 weeks of post-treatment for all groups.
Main Outcome Measures
The Urdu standardized versions of International Index of Erectile Functoning-5 (IIEF-5) and Depression Anxiety Stress Scale-21 (DASS-21) were the main outcome measures.
Results
The mixed repeated measures analysis of co-variance yielded significant impact of both CBST and integrated treatment groups in improving IIEF-5 scores at post treatment as compared to placebo. The CBST group experienced reduction in depression scores at post treatment as compared to both SC and integrated treatment. Only the integrated treatment brought reduction in anxiety scores at post treatment as compared to SC. The covariates age and NOED duration did not significantly impact the treatment outcome for all treatment groups.
Clinical Implications
The efficacy of integrated treatment approach for improving symptoms of NOED and associated depression and anxiety is strong clinical implication of the study.
Strengths & Limitations
The effectiveness of integrated treatment approach in the improvement of NOED symptoms and associated depression and anxiety scores is the main strength of the study. The improvement in depression scores is the added strength of CBST component of integrated treatment approach. The study should have included other PDE5i to compare their effects with the CBST or placebo groups.
Conclusion
The study concludes that the CBST and integrated treatments are treatment of choice for NOED and associated depression and anxiety in young men.
Bilal A, Abbasi NH. Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction. Sex Med 2021;XX:XXXXXX.
... Die Männer, die kombiniert behandelt wurden, zeigten im Verlauf eine weitere Verbesserung der erektilen Funktion und mehrerer anderer sexueller Parameter, während die Männer, die ausschließlich PDE-5-Hemmer bekamen, entweder keine weitere Verbesserung oder eine Abnahme der sexuellen Reaktionen im Verlauf zeigten. Khan et al. (2019) schließen daraus, dass die KVT sich als wirksame Zusatzbehandlung für Männer mit ED erweist, die PDE-5-Hemmer einnehmen, und dass die Vorteile der kombinierten Behandlung viele Monate nach Behandlungsende anhalten. Daher orientieren wir uns an dem Modell der kombinierten Behandlung (Khan et al. 2017(Khan et al. , 2019, ergänzen es um ein vergleichbares Vorgehen zur kognitiv-verhaltenstherapeutischen Sexualtherapie der erektilen Dysfunktion (vgl. ...
... Khan et al. (2019) schließen daraus, dass die KVT sich als wirksame Zusatzbehandlung für Männer mit ED erweist, die PDE-5-Hemmer einnehmen, und dass die Vorteile der kombinierten Behandlung viele Monate nach Behandlungsende anhalten. Daher orientieren wir uns an dem Modell der kombinierten Behandlung (Khan et al. 2017(Khan et al. , 2019, ergänzen es um ein vergleichbares Vorgehen zur kognitiv-verhaltenstherapeutischen Sexualtherapie der erektilen Dysfunktion (vgl. Bilal and Abbasi 2020) und adaptieren es auf die Situation der IPP-Patienten. ...
... Die psychischen Belastungen der von einer IPP betroffenen Männer werden bisher häufig vernachlässigt, scheinen uns aber für eine erfolgreiche Behandlung unabdingbar. Angelehnt an das Collaborative Care Model von Hartzell (2014) schlagen wir ein integriertes Vorgehen vor, das die oben genannten somatischen Ansätze mit Elementen der kognitiv-verhaltenstherapeutischen Sexualtherapie (Bilal and Abbasi 2020;Bossio et al. 2018;de Carufel und Trudel 2006;Hauch 2019;Khan et al. 2017Khan et al. , 2019 kombiniert. Vor dem Hintergrund der individuellen psychosexuellen Lebensgeschichte sowie der emotionalen Verfassung der betroffenen Männer scheint uns die Anpassung der skizzierten sexualtherapeutischen Interventionen an die Spezifika der IPP-Verlaufsphasen (akut vs. chronisch) und die unterschiedlichen Ausprägungen bzw. ...
Zusammenfassung
Einleitung Die Induratio penis plastica (IPP) ist eine erworbene chronische Erkrankung der Tunica albuginea und/oder des Septums der Corpora cavernosa, die zu Deformitäten und Verkrümmungen des Penis führen und die Sexualität der Betroffenen stark beeinträchtigen kann. Darüber hinaus kann die IPP bei den betroffenen Patienten zu emotionalen Problemen und zu Beziehungsproblemen führen.
Forschungsziele Die vorliegende Übersichtsarbeit gibt einen Überblick über die konservativen und chirurgischen Therapieoptionen der IPP, geht detailliert auf die psychischen Besonderheiten und Probleme der Betroffenen ein und stellt mögliche psycho- und sexualtherapeutische Interventionen dar.
Methoden Es handelt sich um eine nicht-systematische narrative Übersichtsarbeit. Mithilfe einer Pubmed-Datenbankanalyse wurden Original- und Übersichtsarbeiten zur IPP identifiziert und im Hinblick auf Methodik und Ergebnisse ausgewertet. Überlegungen zur interdisziplinären Integration einer unterstützenden Psychotherapie werden angestellt.
Ergebnisse Die konservative und die chirurgische Therapie stellen keine kausale, sondern eine symptomatische Behandlung dar. Die Effektivität der konservativen Therapie ist eingeschränkt. Die chirurgische Therapie stellt den Goldstandard zur Behandlung der schweren IPP dar, kann aber Nebenwirkungen wie erektile Dysfunktion und Längenverlust des Penis zur Folge haben. Die IPP führt häufig zu psychischen Belastungen, die im Rahmen einer interdisziplinär integrierten Psychotherapie adressiert werden sollten. Ein entsprechend kombiniertes Vorgehen wird vorgeschlagen.
Schlussfolgerung Um die Erwartungen an die konservative und chirurgische Therapie nicht zu überhöhen, müssen die Patienten über die Möglichkeiten und Limitationen realistisch und ausführlich aufgeklärt werden. Die psychischen Spezifika und Belastungen sollten bei der Therapie der IPP interdisziplinär integriert berücksichtigt werden.
... A total of 13 studies published between 2005 and 2020 were included in the review (Table 1) [24][25][26][27][28][29][30][31][32][33][34][35][36]. The [24][25][26], three studies employed group therapybased interventions [27][28][29], three studies used couple-CBST [30][31][32], and four studies employed internetbased CBT [33][34][35][36]. ...
... A total of 13 studies published between 2005 and 2020 were included in the review (Table 1) [24][25][26][27][28][29][30][31][32][33][34][35][36]. The [24][25][26], three studies employed group therapybased interventions [27][28][29], three studies used couple-CBST [30][31][32], and four studies employed internetbased CBT [33][34][35][36]. PI duration ranged from an average of 4-12 weeks. ...
... Regarding PDE-5i, six studies used sildenafil [25,26,[28][29][30][31], one used vardenafil [32], and six did not specify the drug used by the patients [24,25,[33][34][35][36]. ...
Objectives: To highlight the efficacy of various psychological interventions (PI) when used in combination with, or in place of, phosphodiesterase-5 inhibitors (PDE-5i), as compared to the traditional treatment of men with erectile dysfunction (ED) with PDE-5i alone.
Methods: A comprehensive literature review for the years 2005–2020 via MEDLINE and PubMed. We included randomised controlled trials that compared the use of either PDE-5i alone, PI alone or a combination of PDE-5i and PI in the treatment of psychogenic ED. All studies included were performed in adults aged 19–55 years and were written in English.
Results: A total of 13 articles, with an overall sample of 597 men, were included in this systematic review. The results show that the combination of PI and PDE-5i was more effective than either PI or PDE-5i alone, on erectile function and long-term sexual satisfaction in men with psychogenic ED. Combined interventions were found to be significantly superior to medical treatment in seven studies and to PI alone in one study. In comparing PI to PDE-5i, two studies found PI to be significantly superior to PDE-5i use. In three other studies, PI was found significantly superior to no treatment at all, although some participants in the control group had taken PDE-5i.
Conclusions: The combination of PDE-5i with PI shows real promise for the treatment of psychogenic ED. However, no conclusions could be made about what PI is more promising than the other and larger studies are needed to confirm these initial findings.
Abbreviations: CBT: cognitive behavioural therapy; CBST: cognitive behavioural sex therapy; COVID-19: coronavirus disease 2019; ED: erectile dysfunction; EDITS: Erectile Dysfunction Inventory of Treatment Satisfaction; GPT, group psychotherapy: IIEF(-EF) (-OS) (-SD): International Index of Erectile Function (erectile functioning) (overall sexual satisfaction) (level of sexual desire); ITP: integrative treatment protocol; MHI: Mental Health Inventory; PDE-5i: phosphodiesterase-5 inhibitors; PI, psychological interventions; QoL: quality of life; RCT: randomised controlled trial; SHIM: Sexual Health Inventory for Men
... Male erectile function is closely related to psychological factors [30]. Mental disorders can cause or aggravate ED, and such disorders can be derived from society, family, spouse, and self [30][31]. During PDE5i treatment for ED, the sexual psychological disorders of ED patients will directly influence the effects of PDE5i treatment for ED and could even lead to the lack of a response to the treatment [31][32]. ...
... Mental disorders can cause or aggravate ED, and such disorders can be derived from society, family, spouse, and self [30][31]. During PDE5i treatment for ED, the sexual psychological disorders of ED patients will directly influence the effects of PDE5i treatment for ED and could even lead to the lack of a response to the treatment [31][32]. Fortunately, psychological interventions, such as cognitive behavioral therapy and sexual counseling, can improve the patient's erectile function or enhance the efficacy of PDE5is in the treatment of ED [31][32]. ...
... During PDE5i treatment for ED, the sexual psychological disorders of ED patients will directly influence the effects of PDE5i treatment for ED and could even lead to the lack of a response to the treatment [31][32]. Fortunately, psychological interventions, such as cognitive behavioral therapy and sexual counseling, can improve the patient's erectile function or enhance the efficacy of PDE5is in the treatment of ED [31][32]. Therefore, psychological factors may be another cause of PDE5i nonresponsiveness. ...
Erectile dysfunction (ED) is a common sexual disorder in adult males and one of the most important factors affecting their quality of life and that of their partners. Although PDE5 inhibitors (PDE5is) are the first choice for improving erectile function, there is a substantial proportion of ED patients, termed PDE5i nonresponders, who do not respond to PDE5is. Because of the lack of effective therapies, these patients always have serious social and psychological problems due to ED, which should be addressed. Here, we review the available literature about ED and PDE5is and propose several strategies for mitigating ED in PDE5i nonresponders.
... The CBST takes into consideration such cognitive and behavioral factors related to sexual activity within a sexual relationship. 38,39 Although CBST does not address the neurovascular mechanisms involved in an erectile response, it helps to address the psychological correlates and concomitants associated with ED. 40,41 The CBST involves several components including psychosexual education to the patient, the identification of the problem in context of patient, sexual role play exercises, strategies to reduce performance anxiety, sexual attitudes restructuring, sexual activityerelated Socratic dialog and sexual communication skills building, and so on. 38e40, 44 Recently, mindfulness-based techniques in conjunction with cognitive behavior therapy have also been found useful in the treatment of ED because of situational or psychological causes. ...
... 38,39 Recently, CBST was found to be a potential long-term treatment of choice for ED in Pakistani men. 41 The present research was conducted with a purpose to assess the efficacy of CBST and compare the efficacy of CBST with the efficacy of traditional treatment with SC (PDE5i) in young men diagnosed with NOED. The study specifically aimed to find out the differences in NOED scores on IIEF-5, severity of NOED, and associated depression and anxiety scores at 3 time points in the 2 intervention groups. ...
... Both, the CBST and SC brought about significant differences in NOED scores after treatment and during follow-up compared with before treatment. This finding is important and confirms the recent past study of cognitive behavior therapy effectiveness conducted with Pakistani men for the amelioration of ED. 40,41 These improvements were significantly different after treatment and during follow-up compared with before treatment but were not significantly different during follow-up compared with after treatment. The participants showed stability in NOED scores recorded at follow-up. ...
Introduction
An increasing number of young men have been found to develop nonorganic erectile dysfunction (NOED) in recent years. The NOED has been shown to respond better to cognitive behavior sex therapy (CBST) in a few past studies.
Aim
The present research aims to establish the efficacy of CBST as a promising treatment option in young men suffering from NOED by administering a feasibility pilot trial.
Methods
28 young men (M = 31 years) out of a total of 39 men (7 excluded, 4 quit treatment) diagnosed with NOED from sexual health clinics in Pakistan were recruited to receive CBST treatment (n = 13) on average twice a week for a period of 50 minutes per session for a period of 4, 6, 8, and 12 weeks for the mild, mild to moderate, moderate, and severe forms of NOED, respectively, and sildenafil citrate group (n = 15) receiving sildenafil citrate 50 mg on demand. The trial design was sequential random assignment clinical trial.
Main Outcome Measures
International Index of Erectile Functoning-5 and Depression Anxiety Stress Scale-21 were used before treatment, after treatment, and in follow-up as the main outcome measures.
Results
The repeated measures analysis of covariance established a nonsignificant difference between CBST and sildenafil citrate 50 mg in NOED scores improvement, NOED severity reduction, and reduction in depression scores at posttreatment assessment. There were significant differences among different CBST modalities in improving NOED scores, reduction in NOED severity, and depression scores. There was significant difference in CBST and sildenafil citrate 50 mg in anxiety reduction at posttreatment assessment. The covariates age, age groups, and NOED duration did not significantly impact the treatment outcome for both treatment groups except age which impacted the interaction of treatment and anxiety scores.
Conclusion
The CBST is an emerging and promising treatment choice in younger men suffering from NOED.
... Cognitive behavioural therapy (CBT) has been the subject of extensive research due to its ability to reduce performance anxiety and restructure negative beliefs about sexual performance. A randomised controlled trial conducted during the pandemic revealed that men receiving CBT in conjunction with PDE5i exhibited sustained enhancements in erectile function, while those who used PDE5i as monotherapy experienced no further progress [78]. The International Index of Erectile Function (IIEF) scores remained significantly higher in the CBT group compared to the monotherapy group [78]. ...
... A randomised controlled trial conducted during the pandemic revealed that men receiving CBT in conjunction with PDE5i exhibited sustained enhancements in erectile function, while those who used PDE5i as monotherapy experienced no further progress [78]. The International Index of Erectile Function (IIEF) scores remained significantly higher in the CBT group compared to the monotherapy group [78]. A randomised controlled trial conducted during the pandemic of severe acute respiratory syndrome (SARS-CoV-2) found that online CBT significantly improved erectile functioning, self-esteem, and reduced depression and anxiety among men with nonorganic ED [79]. ...
The prevalence of erectile dysfunction (ED) among the male population worldwide has significant ramifications for their quality of life and psychological well-being. This narrative review explores both conventional treatments, such as pharmacotherapy and surgery, and emerging approaches, including regenerative therapies, dietary interventions, physiotherapy, and vacuum erection devices (VEDs). Unlike prior reviews, this study emphasises unconventional therapies and their role in comprehensive ED management. A systematic literature review was conducted using PubMed, Embase, and Medline, including studies published up to 2024. Keywords such as “ED”, “pharmacotherapy”, “shock wave therapy”, “regenerative medicine”, and “dietary interventions” were used to identify relevant studies. Eligible studies examined treatment efficacy, mechanisms, and patient outcomes. Phosphodiesterase type 5 (PDE5i) inhibitors remain the primary treatment, demonstrating effectiveness across diverse populations. Regenerative therapies, including stem cells and platelet-rich plasma (PRP), show promise, but require further validation. Surgical interventions, particularly penile prostheses, provide high patient and partner satisfaction. Non-invasive methods, including physiotherapy and dietary changes like adoption of the Mediterranean diet, improve vascular health and erectile function. The efficacy of VEDs as standalone or adjunct treatments has been demonstrated, enhancing outcomes in prosthetic surgery. A multimodal, personalised approach is essential for optimising ED treatment. Despite promising advancements, gaps remain in terms of long-term data, standardised protocols, and partner-centred outcomes. Future research should focus on large-scale, multi-centre trials and synergistic treatment approaches to improve therapeutic outcomes and patient satisfaction.
... Fruhauf and colleagues' systematic review on RCTs of psychological treatments 149 highlighted the limited evidence of efficacy of psychological interventions on ED, with most studies characterized by small sample size and the low statistical power. 150 Most research about CBT interventions has assessed combined treatment (see the section on combined interventions), and these have become the preferred approach to ED. 151 However, the possibility of delivering iCBT and the existence of more powered trials aimed at specific groups (eg, young adults) and with diverse samples 152 have renewed research in the field and established evidence that CBT may be an effective therapeutic answer to ED with better results than combined treatment in improving mental health indicators (anxiety). 153 ...
... RCTs have demonstrated improved outcomes for ED when combining medical treatment and psychotherapy, especially in cases where anxiety is a contributing factor. 94,97,144,145,[149][150][151][221][222][223][224] Similarly, combining on demand pharmacotherapy and behavioral therapy techniques has shown enhanced treatment responses for PE. [142][143][144][225][226][227][228] However, research on other combination treatments for male sexual dysfunction is limited. ...
Introduction
Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.
Objectives
This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.
Methods
A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.
Results
Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.
Conclusions
This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.
... In addition, cognitive-behavioral sex therapy (CBST) has been widely applied in the treatment of erectile dysfunction (ED) in men. The adjunctive use of CBT has been shown to have long-term beneficial effects on ED patients receiving Phosphodiesterase Type 5 Inhibitor (PDE5i) treatment [9]. Another study showed that the CBST group had significantly improved International Index of Erectile Function-5 (IIEF-5) scores and reduced depression scores compared to the placebo group after treatment [10]. ...
... We identified two randomized controlled studies on the efficacy of CBT for patients with sexual dysfunction. The results showed that CBT was an effective and supportive adjunctive treatment for Pakistani men with erectile dysfunction (ED) who were taking type 5 phosphodiesterase inhibitors, and the treatment effect lasted longer [9]. Another randomized controlled study investigated the effect of CBT on the sexual function, marital adjustment, depression, and anxiety levels of women with vaginal spasm and their husbands. ...
Background
Premature ejaculation (PE) is one of the most common male sexual dysfunctions, with a prevalence of about 4%-39% in the Chinese population. Studies have shown that a variety of biological factors can lead to premature ejaculation, such as central nervous system disorders, hypersensitivity of the penis head, and psychological factors. Based on clinical experience, psychological counseling and education of patients and partners should be ranked as the first priority when treating PE. Cognitive behavioral therapy (CBT) addresses emotional, behavioral, and cognitive disorders by altering beliefs and actions. It has also been demonstrated to be clinically useful in treating a number of diseases. The purpose of this trial is to evaluate the efficacy of a mobile-based CBT intervention on patients with PE compared to conventional routine treatment.
Methods
This study is a prospective randomized controlled trial that will be conducted from May 2023 to Dec 2024 at ten hospitals, primarily including the First Affiliated Hospital of Sun Yat-sen University with an 8-week follow-up. The clinical trial central randomization system will be used to create and implement the specific randomization method. Baseline data of both groups will be measured and collected. The premature ejaculation diagnostic tool (PEDT) and the female sexual distress scale-revised for premature ejaculation (FSDS-R-PE) will be collected on the first day, 28±2 days, and 56±2 days during the intervention period, and the intravaginal ejaculatory latency time (IELT) will be measured in both groups. The Shapiro-Wilk test will be used for normality testing. Pearson correlation analysis will be used for correlation analysis. Differences between groups will be compared using analysis of variance or exact probability calculations.
Discussion
This study will investigate the effect of a mobile-based CBT intervention on patients with PE.
Trial registration
Chinese Clinical Trial Registry (ChiCTR2300070581).
... [7] The current management approach for such patients is to integrate both PDE5i and psychotherapy. [8] In developing countries like Pakistan where modern PDE5i are still not licensed and registered by the Drug Regulatory Authorities (DRAP), [9] the common approach is to integrate non PDE5i with psychotherapy or use non-PDE5i alone. [10] The current guidelines for the management of ED can not be fully implemented in Pakistan due to such hurdles. ...
... [14,15] The cognitive restructuring of the core beliefs and challenging of automatic thoughts make this approach long lasting in its effects. [8,14] The efficacy of CBST underscores the importance and efficacy of psychosocial approaches in the management of ED in young men. [12] The efficacy of CBST for improving NOED in Pakistani young men makes it a treatment of choice. ...
Some studies with Western men have shown promising results for the efficacy of cognitive behavior sex therapy (CBST) in the treatment of erectile dysfunction. The two randomized controlled trials were conducted to assess the efficacy of CBST as a treatment of choice for young men with non-organic erectile dysfunction (NOED). The two randomized controlled trials were run to assess the efficacy of CBST and integrated treatment approaches for the treatment of NOED in young Pakistani men. The two studies were registered with ClinicalTrials.gov vide No. NCT04179747 and NCT04126252. The sex therapy techniques were combined with cognitive behavior therapy and mindfulness to develop an indigenous approach for the treatment of NOED in young Pakistani men. The CBST significantly improved International Index of Erectile Functioning-5 scores in two studies. The CBST also decreased depression scores associated with NOED. The CBST is a treatment of choice for young Pakistani men with NOED. The CBST is also significant in improving the mental health conditions associated with NOED.
... The present primary line of treatment for ED in CP/CPPS includes the administration of phosphodiesterase type 5 (PDE-5) inhibitors, 18 which may improve the physiologic-evans-Durán et al al components of ED yet neglect the omnipresent mental components. The present study's evidence for the role that psychological factors have in perpetuating poor sexual functioning in patients with CP/CPPS offers evidence for the incorporation of psychotherapy, such as cognitive behavioural therapy (CBT), into current treatment standards. ...
... CBT, in conjunction with pharmaceutical agents, has been shown to lead to extended improvements upon sexual parameters in men with ED compared to the use of pharmaceutical agents alone. 18 In a feasibility trial, Nickel et al 19 found that a cognitive behavioral symptom management program for CP/ CPPS significantly reduced patients' levels of pain catastrophizing, disability, and pain, but not depressive symptoms. This program challenged patients' illness-focused coping and catastrophic cognitions, potentially explaining the improvements in catastrophizing but not depressive symptomatology, although the two have been found to be highly related. ...
Introduction:
The present study sought to examine a new model to evaluate the mechanistic pathways between pain and sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), incorporating cognitive and social factors.
Methods:
Men with a self-reported diagnosis of CP/CPPS (n=94, 24-69 years, Mage=44.22, standard deviation 11.25) were recruited through social media, support groups, and urology clinics and completed an online questionnaire of demographic, pain, cognitive, psychological, and sexual variables. Descriptive statistics, correlation analysis, and serial mediation analyses assessed variable associations.
Results:
Almost half of participants reported mild to severe erectile dysfunction (47.4%). Sexual dysfunction was associated with greater pain symptom severity and pain catastrophizing, as well as depressive symptoms (p<0.01 for all). While pain did not independently predict levels of sexual dysfunction, the addition of pain catastrophizing and depressive symptoms into the pathway explained the association between increased pain symptoms and decreased sexual functioning (p<0.01).
Conclusions:
Beyond generally poor sexual functioning in the current sample, it appears as if cognitive and emotional factors play a role in the association between pain symptoms and sexual functioning in these men with CP/CPPS. The findings of how pain catastrophizing and depression impact the association of pain severity and decreased sexual functioning is important for improving patient care.
... In contrast, men may struggle more prominently with the stigma associated with erectile dysfunction, anxiety regarding sexual performance, and concerns about masculinity [176][177][178]. CBT aimed at reducing performance anxiety, addressing feelings of shame, and promoting acceptance can enhance recovery [179,180]. Tailoring psychological interventions to these gender-specific needs is essential to optimizing outcomes and improving overall QoL. ...
Sexual dysfunction following abdominal or pelvic surgery is a significant concern that impacts the quality of life (QoL) for both men and women. This paper explores the multifaceted challenges and re-educational strategies associated with post-surgical sexual dysfunction. It highlights the physical and psychological repercussions of surgeries such as hysterectomies, pelvic organ prolapse repairs, radical prostatectomies, and rectal cancer resections. These procedures often lead to complications like dyspareunia, erectile dysfunction, and altered body image, necessitating comprehensive re-educational approaches. The review emphasizes the importance of tailored interventions, including pelvic floor muscle training (PFMT), biofeedback, manual therapy, and advanced techniques like botulinum toxin injections and sacral neuromodulation. For men, strategies such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), intracavernosal injections, and penile prostheses are explored for their efficacy in restoring erectile function. Psychological support, including cognitive–behavioral therapy and couples counseling, is underscored as essential to addressing emotional and relational aspects of recovery. A multidisciplinary approach involving physiatrists, urologists, gynecologists, physiotherapists, psychologists, and sexual health counselors is advocated for to optimize outcomes. Integrating physical therapy modalities, as well as psychological and relational therapies, into individual rehabilitation projects is crucial for improving sexual function and overall QoL post-surgery. Future research should focus on refining these established strategies and investigating the potential of innovative therapeutic modalities.
... Furthermore, men in the medication alone group showed decreased sexual function over time, whereas in the combination of sex therapy plus medication group, gains in sexual function remained and additionally, depressive and anxiety symptoms also diminished (Frühauf et al, 2013;Aubin et al, 2009;Bilal & Abbasi, 2022). The longer the follow up the better are results for the combined treatment, and the worse for monotherapypharmacotherapy group alone (Khan et al, 2019). This is probably the consequence of the fact that combination therapy addresses sexuality related beliefs and sexual activity related behaviours, and not just erection or ED symptoms. ...
Sexual therapy is a relatively new development in the treatment of erectile dysfunction and other sexual dysfunctions. During the 19th and 20th century different methods of treatment were used for management of impotence0F0 F
1. In cases of psychological („psychogenic“) impotence, the most used treatment during the first half of the 20th century was psychodynamic (analytic) individual therapy, but with very poor results1F1F2. During the 1960s Masters and Johnson did their seminal work on human sexual response cycle (and published it in a book Human sexual Response, 1965). Next, they developed a programme of treatment for people with different sexual dysfunctions (but primarily for patients with erectile dysfunction) (it was described in another book, Human sexual inadequacy, 1970). This therapy is called (psycho)sex(ual) therapy. Helen Singer Kaplan further developed sex therapy, as explained in her book The new sex therapy (1974) (Lew-Starowich et al, 2021). Her approach was a combination of psychodynamic, systemic and behavioural approaches, including pharmacotherapy (Kirana, 2015). Many other therapists (such as Heiman, LoPiccolo, Annon, Leiblum, Tiefer and others) further enriched sex therapy (Masters et al, 2006; Weiner & Avery-Clark, 2014).
... It is important to note that the selected pharmacotherapy was 50 mg of sildenafil citrate, emphasizing the need to specify and compare with various alternative options. The study by Khan et al. (2019) involved a 15-to 18-month follow-up assessment of a subset of 20 men receiving either monotherapy with iPDE-5 or combination therapy. The results were similar to those described earlier, but after 15 to 18 months, the obtained effects were not associated with changes in relationship satisfaction or mental health indicators, emphasizing the need for dynamic and long-term monitoring. ...
This study aimed to investigate the effects of psychotherapeutic interventions, specifically cognitive-behavioral sexual therapy, using the example of erectile dysfunction in a cohort of 58 Ukrainian men under the age of 40 years. To achieve this goal, questionnaire methods were employed, including questions from the International Index of Erectile Function and the Perceived Stress Scale, along with statistical data processing and subsequent discussion. Psychotherapeutic intervention demonstrated its effectiveness from the short-term perspective and over a period of 6 months, with a significant improvement in erectile function indicators and a reduction in distress scores in the group of patients undergoing combined therapy (p < .05). Monotherapy with phosphodiesterase-5 inhibitors, as first-line drug choices, also proved effective. However, considering that erectile dysfunction had an established psychogenic nature, the symptoms of the condition returned to the baseline level after 6 months. Providing psychosexual education and studying adaptive sexual responses with the disruption of maladaptive cognitive patterns should be a key goal in the treatment of psychogenic sexual dysfunctions. It is important to note that men may encounter difficulties in the practical application of various cognitive-behavioral sexual therapy techniques. Nevertheless, psychotherapy is considered a promising approach to treatment, especially in the context of countries where the topic of sexual education remains taboo, and the number of men seeking professional psychological help is very low, as is the case in Ukraine.
... Cognitive behavioral therapy (CBT), in particular, is a versatile therapeutic approach that has shown effectiveness across a range of mental health conditions, including suicide prevention, anxiety, and depression [19]. CBT can also be beneficial for patients experiencing ED, particularly when psychological factors such as anxiety and stress contribute to the condition [20]. By addressing maladaptive thought patterns and behaviors, CBT can help patients manage the emotional and cognitive aspects of ED, reducing psychological distress and improving sexual health outcomes. ...
Background
Diabetes mellitus is a chronic metabolic disorder that can lead to various complications, including erectile dysfunction (ED). Therefore, this study aimed to investigate the relationship between ED and psychological factors (anxiety, stress, and depression) in Erbil City, Iraq.
Methodology
Using a purposive sampling method, this cross-sectional study was conducted from June 15th to November 27th, 2023, at the Layla Qasim Center in Erbil City. The questionnaire included demographic information, the Depression, Anxiety and Stress Scale - 21 Items for assessing depression, anxiety, and stress, and the International Index of Erectile Dysfunction Questionnaire. Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX, USA). Significance levels were considered at p-values <0.05.
Results
A total of 403 participants were included in the study. The mean score for depression was 9.95 ± 4.99, indicating moderate levels of depression. Anxiety levels were more severe, with a mean score of 9.25 ± 4.25, while stress levels were moderate with a mean score of 11.63 ± 3.91. ED scores indicated mild-to-moderate ED, with a mean score of 13.46 ± 4.30. There was a significant negative correlation between ED and depression (r = -0.11, p < 0.001), anxiety (r = -0.16, p < 0.001), and stress (r = -0.13, p < 0.001).
Conclusions
The study demonstrated a significant negative correlation between ED, depression, anxiety, and stress among diabetic patients. Policymakers and healthcare providers should develop targeted interventions to address psychological factors and support ED in diabetic patients.
... 17 Similarly, another study with Pakistani men reported that psychosexual education-based therapy was effective at maintaining the improvement in symptoms of erectile dysfunction later at 15-18 months follow-up. 31 A study was conducted with 188 young men visiting an outpatient department of a large hospital in Karachi Pakistan. Thirty-one and sixty-three percent of the respondents believed that masturbation could lead to physical illnesses and to weakness. ...
Sex education has been found to be associated with informed sexual decision making and enhanced sexual well-being. But in Pakistan, sex education has been remained a subject of taboo and stigma and has been associated with a number of myths. This article tries to discuss the current state of sex education in Pakistan by justifying the need for the sex education and uncovering the factors responsible for the non-implementation of sex education on mass level in Pakistan. Two major factors considered responsible for a lack of implementation of sex education are several myths associated with the sex education and portrayal of sex education as fundamentally non-Islamic. This article analyzes the scientific validity of several myths associated with the sex education and proposes that sex education is not against the Islamic traditions and values. The sex education needs to be embedded in existing cultural and educational setup of Pakistan so that it may be accepted. This study highlights the comprehensive nature of United Nations Educational, Scientific and Cultural Organization (UNESCO) guidelines in the development and implementation of sex education and explores the implementation of sex education under the umbrella of Life Skills Based Education (LSBE) developed by the School Education and Literacy Department of Government of Sindh. This article further proposes steps to implement LSBE on mass level by involving parents, religious leaders, teachers, provincial education boards, and universities. It is further suggested that LSBE should be delivered as part of traditional educational system in a step by step manner and should be in accordance with the cultural norms of Pakistan.
... Main goals are the identification and correction of any negative thoughts or beliefs that may interfere with his sexual function or satisfaction [6]. Psychotherapy can be delivered individually or in group sessions, using various techniques such as cognitivebehavioral therapy (CBT), mindfulness-based therapy, or hypnotherapy [89][90][91]. Couples therapy is a form of psychological intervention that aims to support the patient and his partner communicate better about their sexual concerns and expectations, enhance their intimacy and trust, and resolve any conflicts or issues that may affect their sexual function or satisfaction. It can also help the partner cope with his or her own emotional reactions to the patient's ED, such as frustration, anger, resentment, or rejection [92]. ...
Purpose of Review
Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers.
Recent Findings
The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient’s preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I–II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient’s sexual function or relationship.
Summary
This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.
... For example, a study of 31 men with erectile dysfunction found that an 8-week stress management program was effective in reducing perceived stress and cortisol levels, but there were no significant effects on erectile function (Kalaitzidou et al., 2014). In another small-sample study of 20 men with erectile dysfunction, those assigned to 10 weeks of cognitive behavioral therapy showed greater improvements in erectile function than those in the control group (Khan et al., 2019). In these studies, men in both control and intervention groups were also using PDE5 inhibitors in their treatment of erectile dysfunction. ...
Erectile dysfunction is a major chronic condition affecting hundreds of millions of individuals worldwide. This review provides a concise overview of research on the psychological experience of erectile dysfunction. There is evidence that psychological factors such as personality, depression, stress, and cognitive interference (e.g., performance worry, shifts in attentional focus) contribute to erectile problems. There is also evidence that the experience of erectile dysfunction can have negative psychological effects, including feelings of emasculation and humiliation, decreases in self-confidence and feelings of self-worth, feelings of isolation and loneliness, increases in depression, and decreases in subjective well-being. Effects on the affected individuals’ sexual partner include feelings of being unattractive, feelings of rejection, feeling unloved, decreases in self-esteem, and frustration. Psychological interventions (particularly multimodal interventions) show promise for treating erectile dysfunction, but more research is needed to help establish their effectiveness. We present a brief research agenda of critical areas in need of further study. This review should be of interest to the general public and also researchers looking to develop a program of research in sexual health psychology that focuses on the psychological experience of erectile dysfunction.
... Khan 18 60 men with ED IIEF Men in the cognitive behavioral therapy group showed greater improvement on IIEF subscales of erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction than those in the control group. Khan 19 15-to 18-month follow-up on 20 men in the previous study IIEF, MHI-D&A For those in the combined therapy group, sexual response continued to improve, whereas those receiving only medication showed moderate regression of sexual function. Lottman 20 15 patients in ICI + counseling group, 3 sessions of 1 h ...
Introduction
Treatments for erectile dysfunction (ED) have undergone a historical progression that includes more sophisticated and reliable penile prostheses, multiple formulations for intracavernosal injections, vacuum tumescence devices, intraurethral suppositories, phosphodiesterase type 5 inhibitors, and experimental use of low-intensity shockwave therapy. Even with all these impressive interventions, the adverse psychological impact of ED on the patient, partner, and couple is often overlooked. Some clinicians believe that these treatments simply override the negative psychological or relational impacts of the ED. In the ideal patient or couple, this is true; however, in a significant number of cases (31%-57%), the efficacious ED interventions are prematurely discontinued and do not work to their potential, and the psychological sequelae of ED remain or worsen.¹
For >20 years, clinicians have advocated for combining ED medical interventions with psychosexual therapy to enhance the efficacy of the intervention, decrease discontinuation rates, and improve sexual and relational satisfaction.²⁻⁸ Furthermore, for special populations of men, such as those who have undergone treatment for prostate cancer, combination therapy is essential in penile rehabilitation efforts.
... A holistic approach which considers the biological, psychological and relational aspects is the advised treatment for ED. Integrated medical and psycho-sexological therapy requires a mutual understanding of, and respect for, the different disciplines involved in the management of all sexual dysfunctions [270,[284][285][286]. Cognitive behavioral therapy (CBT) was found to be an effective treatment strategy for non-organic ED, or even organic ED with important cognitive and behavioral comorbidities or a non-organic nature [146,287,288]. ...
PurposeErectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized.Methods
The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.ResultsSeveral evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed.Conclusions
These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.
... Erectile dysfunction (ED) is defined as the persistent inability to achieve and maintain an erection hard enough to permit satisfactory sexual intercourse [1]. According to the five-item International Index of Erectile Function questionnaire (IIEF-5) score, ED severity is classified on severe (score 1-7), moderate (8)(9)(10)(11), mild-moderate (12)(13)(14)(15)(16), mild (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25) [2]. ED has become a major health concern even in younger men, causing a significant impact on men's quality of life [3]. ...
Purpose of Review
This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Cochrane databases was done. Papers in English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports, clinical cases, or clinical trials protocols with no results were also excluded.
Recent Findings
We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal theraphy, psycho-sexual theraphy). However, others (some new molecules, stem cell theraphy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations.
Summary
Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as effective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.
... In this respect, the women's strong emotional positivity regarding their experience may have led them to overestimate the actual reduction in PTSD symptoms. Interestingly, we found comparable strong positivity (i.e., stronger and more enduring effects) among men in Pakistan with sexual problems who were given the opportunity to supplement pharmacological treatment with "talk-based" therapy, an option rarely afforded Pakistani men experiencing sexual difficulty [74]. ...
Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10–12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improvement. In conclusion, therapy was associated with a reduction in PTSD symptoms regardless of literacy level of participants. This reduction in PTSD was notable because, unlike many situations involving spousal abuse, these women were generally not in a position to leave their relationship, and hence the women might have experienced continued exposure to abuse. Context/cultural-based explanations for these findings are presented and discussed.
Objectives:
To evaluate whether the presence of sexual problems in men (i.e., erectile dysfunction, premature ejaculation, or delayed ejaculation) is associated with differential sexual behavior during masturbation and partnered sex.
Methods:
Cisgender participants (n = 2,807) completed an internet-based, cross-sectional questionnaire about sexual interest, behavior, and functioning.
Results:
Men with premature ejaculation were less likely to engage in foreplay-type behaviors, whereas men with erectile dysfunction or delayed ejaculation were more likely to include self-stimulation and/or other stimulation strategies during partnered sex.
Conclusions:
Different behavioral patterns among dysfunctional men represent potential strategies for modulating sexual arousal levels.
Introduction
Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023.
Objectives
Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area.
Methods
An expert panel reviewed existing research and clinical practice guidelines.
Results
Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications.
Conclusion
Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth.
Vaginismus is one of the most common GenitoPelvic Pain/Penetration Disorders, which is classified as either lifelong (primary) or acquired (secondary). The present study aimed to investigate the efficacy of Cognitive Behavioral Therapy on women with lifelong vaginismus. During a single-case experimental trial of multiple-baseline type, four women were included and diagnosed with lifelong vaginismus by a psychiatrist in a psychosexual clinic in Ahvaz. Full intercourse was evaluated daily based on the self-reports of participants. Secondary outcome measures (i.e.catastrophic cognitions, tightening, helplessness, sexual adjustment, avoidance, and penetration motivation were assessed in participants by a multidimensional vaginal penetration disorder questionnaire at baseline and after intervention. The subjects were entered into an eightweek Cognitive Behavioral Therapy program. The decreasing curve is compared with the baseline for each variable and considered the recovery index. After the treatment, all participants reported successful intercourse without pain and fear. The findings investigated that catastrophic cognitions, tightening, helplessness, sexual adjustment, avoidance, penetration motivation, sexual information, hypervigilance, optimism, and thoughts about genital incompatibility significantly improved by Cognitive Behavioral Therapy in all participants(P < 0.05). Based on the results, Cognitive Behavioral Therapy can be considered an effective treatment for LLV. In addition, this study can enhance our knowledge about the fear-avoidance essence of vaginismus and develop treatment options for women with lifelong vaginismus. Future studies are recommended with larger sample sizes and control groups.
Background:
Previous research has documented the impact of the COVID-19 pandemic on male sexual and mental health. However, no prior study has evaluated the efficacy of online cognitive behavioral therapy (CBT) during the COVID-19 pandemic for treating nonorganic erectile dysfunction (ED) by improving negative emotions and self-esteem.
Aim:
To test the efficacy of online CBT for nonorganic ED during the COVID-19 pandemic in Shanghai, China.
Methods:
A randomized controlled trial was conducted during the COVID-19 pandemic. Paired t-tests and 1-way analysis of variance were used to analyze and compare erectile functioning, self-esteem, and emotional state between and within groups.
Outcomes:
The main outcome measures included scores on the 5-item International Index of Erectile Function, Rosenberg Self-esteem Scale, 9-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder scale to evaluate erectile functioning, self-esteem, depression, and anxiety, respectively.
Results:
In the CBT group, erectile functioning, intercourse satisfaction, orgasmic functioning, sexual desire, and overall satisfaction were significantly improved at posttreatment as compared with pretreatment (P < .05). After treatment, group differences in emotional state and self-esteem were observed between the CBT group and the control group. Results revealed that the CBT group had significantly better scores than the control group at posttreatment on the Rosenberg Self-esteem Scale (mean ± SD, 30.43 ± 6.51 vs 22.67 ± 10.74), Patient Health Questionnaire (7.07 ± 2.74 vs 11.07 ± 4.41), and Generalized Anxiety Disorder scale (8.36 ± 1.97 vs 11.13 ± 3.94; P < .05).
Clinical implications:
This study represents an important advance in understanding of the efficacy of online CBT for treating nonorganic ED in reproductive-age males during the COVID-19 pandemic.
Strengths and limitations:
The study participants, treatment modality, and COVID-19 pandemic background of this study are innovative and therefore strengths. However, our study has several limitations-namely, its sample size and use of self-report data to measure erectile functioning due to the pandemic. Further studies should incorporate sexual functioning-monitoring instruments as well as self-report data to measure erectile function.
Conclusion:
Online CBT clearly improved the emotional state and self-esteem of patients with ED during the COVID-19 pandemic.
Erectile dysfunction is a multifactorial problem that requires various treatment approaches based on the factors affecting disease development. Erectile dysfunction is one of the most serious clinical and social is-sues among men. It’s obvious that a full sexual life is one of the most important components of physical and mental health. Recent sociological data show that sexual health is the key not only to a good quality of life, but also to a longer life expectancy. It is noted that combining the traditional three-stage therapy – oral drugs, penile injection therapy and penile implantation – with ongoing psychotherapy can significantly improve the treatment results. Accordingly, it becomes important and crucial for a specialist to be aware of the timely referral of a patient to a psychotherapist.
Sexual dysfunction in men can be manifold. Purely mechanical disorders of seminal deposition due to anatomy are to be differentiated from functional libido and orgasmic disorders, from ejaculation problems or the inability to achieve or maintain erections. While pure orgasmic disturbances are almost in all cases due to psychological or psychiatric causes, libido and erectile dysfunction may also have hormonal causes and thus be symptoms of androgen deficiency. Additional clinical symptoms of hypogonadism or objectifiable findings such as testicular atrophy, changes in secondary sexual characteristics, or ejaculate volume allow the organic genesis to be identified in pronounced cases, while in other cases the corresponding indications must be actively sought. Thus, while functional orgasmic and libido disorders are the domain of psychological psychiatric or endocrinological therapeutic approaches, this chapter deals primarily with disorders of seminal deposition and functionally or organically caused disorders of cohabitation.
Introduction
Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far.
Aim
To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM).
Method
A comprehensive, narrative review of the literature was performed.
Main outcome measures
Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided.
Results
A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable.
Conclusion
Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect.
Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;XX:XXXXXX.
Criteria for premature ejaculation (PE) were established using Western‐based samples, yet these criteria are applied worldwide for its diagnosis. This study (a) determined whether men from various world regions differ/agree on their views of ejaculation latency (ELT) and their perceptions of ejaculatory control and bother/distress, the three criteria for PE, and (b) compared PE and non‐PE men across worldwide regions on these measures. 1,065 participants were recruited via social media to respond to a survey about men's typical, ideal and PE ELTs, about their own ELT, and about perceptions of ejaculatory control and bother/distress related to PE. Responses from men from four worldwide regions were compared to a reference group of North American/European men, and PE men were compared with non‐PE men across three world regions. Results showed that most world region groups showed similarity in ELT estimations. The Sub‐Saharan group focused more heavily on the importance of ejaculatory control. Both ELT and ejaculatory control differed between PE and non‐PE groups in all regions assessed. In conclusion, perceived ELTs and ejaculatory control show substantial consistency across world regions despite geo‐cultural variations and traditions. Such findings argue for the universality of the concepts of ELT, control and bother/distress related to PE.
Although cross-cultural research is currently being conducted in many countries, on many subcultures, and by many research groups, much of this research either is not visible to the practitioner or does not specifically inform the practitioner as to how it might affect healthcare provider–client interactions. We argue for the need to include culturally relevant variables in standard research protocols, delineating research that addresses the healthcare experiences of cultural subsets from research designed to understand basic issues, attitudes, and differences within those cultural subsets. Finally, we offer ways in which various types of research investigations might be implemented within clinic settings and through various kinds of international collaborations.
Background:
About 30–40% of the population report sexual dysfunction. Although it is well-known that the brain controls sexual behavior, little is known about the neural basis of sexual dysfunction.
Aims:
To assess convergence of altered brain activity associated with sexual dysfunction across available functional imaging studies.
Methods:
We used activation likelihood estimation (ALE) meta-analysis to quantify interstudy concordance across 14 functional imaging studies reporting 179 foci from 40 individual analyses involving 191 subjects with sexual dysfunction and 123 controls.
Outcomes:
ALE scores were used to assess convergence of findings.
Results:
Consistently decreased brain activity associated with sexual dysfunction was identified in the dorsal anterior cingulate cortex, ventral striatum, dorsal midbrain, anterior midcingulate cortex, and lateral orbitofrontal cortex.
Clinical Translation:
These findings can serve as a basis for further studies on the pathophysiology of this highly common disorder with the view to development of more specific treatment strategies.
Strengths & Limitations:
Findings are based on an observer-independent meta-analysis that provides robust evidence for and anatomical localization of altered brain activity related to sexual dysfunction. Our analysis cannot distinguish between the putative sources of sexual dysfunction but provides a more ubiquitous and general pattern of related altered neural activity.
Conclusion:
The identified regions have previously been shown to be critically involved in mediating sexual arousal and to be part of the sympathetic division of the autonomic nervous system. This suggests that the disturbance of brain activity associated with sexual dysfunction primarily affects sexual arousal already at early stages that are controlled by the sympathetic nervous system.
The present study aimed to translate and validate Mental Health
Inventory (Veit & Ware, 1983). It was done in three phases. Phase
I involved the translation of Mental Health Inventory through back
translation method. Phase II aimed at establishing psychometric
properties of the measure. For this purpose, sample consisting of
600 individuals (325 men, 275 women) with age ranging between
21 to 50 years was taken from different spheres of life.
Psychometric properties were determined by item-total correlation,
alpha reliability coefficients, and exploratory factor analysis.
Factor analysis revealed two factors namely Psychological WellBeing
and Psychological Distress. Results showed that mental
health was positively correlated with psychological well-being and
negatively correlated with psychological distress. Similarly,
psychological well-being was negatively correlated with
psychological distress. Results also indicated significant gender
differences on psychological well-being and psychological distress
as men reflected higher psychological distress and less
psychological well-being as compared to women. Translated
Mental Health Inventory was validated in Phase III by comparing
people diagnosed with and without Major Depressive Disorder.
Sample consisted of 80 individuals with equal number of
diagnosed and healthy individuals taken from different hospitals.
There were significant differences between both groups as healthy
people reflected better mental health than diagnosed patients.
Future implications of the study were also discussed.
Keywords: Mental health, psychological well-being, psychological
distress
Background:
Some studies have reported that exposure to depression increases the risk of erectile dysfunction (ED), whereas others have observed no association. Moreover, additional studies have reported that exposure to ED increases the risk of depression.
Aim:
To identify and quantitatively synthesize all studies evaluating the association between ED and depression and to explore factors that may explain differences in the observed association.
Methods:
We conducted a systematic review and meta-analysis. We searched Medline, Ovid Embase, and the Cochrane Library through October 2017 for studies that had evaluated the association between ED and depression. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting (PICOS) inclusion criteria.
Outcomes:
The odds ratio (OR) was regarded as the effect size, and the heterogeneity across studies was assessed using the I2 statistic.
Results:
We identified 49 eligible publications. The pooled OR for studies evaluating depression exposure and risk of ED was 1.39 (95% CI: 1.35-1.42; n = 46 publications with 48 studies). Although we observed large heterogeneity (I2 = 93.6%), subgroup analysis indicated that it may have been as a result of variations in study design, comorbidities, ED assessment, depression assessment, the source of the original effect size, etc. No significant publication bias was observed (P = .315), and the overall effect size did not change by excluding any single study. The pooled OR for studies evaluating ED exposure and risk of depression was 2.92 (95% CI: 2.37-3.60; n = 5 publications with 6 studies). No significant heterogeneity (P < .257, I2 = 23.5%) or publication bias (P = .260) was observed.
Clinical implications:
Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED.
Strengths and limitations:
There are several strengths to this study. First, evaluations of the association between ED and depression are timely and relevant for clinicians, policymakers, and patients. Second, we intentionally conducted 2 meta-analyses on the association, allowing us to include all potentially relevant studies. However, our study also possesses some limitations. First, the OR is a measure of association that only reveals whether an association is present. Thus, this study was unable to determine the direction of causality between ED and depression. Second, the high heterogeneity among studies makes it difficult to generalize the conclusions.
Conclusion:
This study demonstrates an association between depression and ED. Policymakers, clinicians and patients should attend to the association between depression and ED. Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018;xx:xxxx-xxxx.
What is Qualitative Interviewing? is an accessible and comprehensive ‘what is’ and ‘how to’ methods book. It is distinctive in emphasizing the importance of good practice in understanding and undertaking qualitative interviews within the framework of a clear philosophical position. Rosalind Edwards and Janet Holland provide clear and succinct explanations of relevant philosophies and theories of how to know about the social world, and a thorough discussion of how to go about researching it using interviews. A series of short chapters explain a range of interview types and practices. Drawing on their own and colleagues’ experiences Edwards and Holland provide real research examples as informative illustrations of qualitative interviewing in practice and the use of creative interview tools. They discuss the use of new technologies as well as tackling enduring issues around asking and listening, and power dynamics in research. Written in a clear and accessible style the book concludes with a useful annotated bibliography of key texts and journals in the field. What is Qualitative Interviewing? provides a vital resource for both new and experienced researchers across the social science disciplines.
Introduction: erectile dysfunction (ED) is currently one of the most common sexual dysfunctions worldwide but it is usually underestimated because it is not a life threatening condition. The associated stigma makes men who have it to suffer in silence. This study was conducted to determine the prevalence of erectile dysfunction and the possible associated risk factors among Nigerian men.
Methods: the study was a descriptive cross-sectional population based survey among men aged 30-80 years in Ogbomoso, South-west, Nigeria. A multistage random sampling method was used. The instrument used was the International Index of Erectile Function Questionnaire-5 (IIEF-5). Unadjusted odds ratios of possible risk factors were calculated by univariate analyses. Binary logistic regression analysis was used to eliminate the effect of possible confounders on the risk factors to get the adjusted odds ratios.
Results: the general prevalence of ED in this study was 58.9%. Sixty-seven (47.2%), 16 (11.3%) and 59(41.5%) respondents had mild, moderate and severe ED respectively. Age, hypertension, use of anti-hypertensive drugs, diabetes mellitus and heart disease all had significant unadjusted associations with ED, but their adjusted associations were not statistically significant. Diabetes mellitus maintained a positive statistically significant relationship with ED after adjustment for potential confounders [OR= 8.31(95% CI 1.02 - 67.65), P= 0.048].
Conclusion: the prevalence of ED is high among south-western Nigeria male adults. Physicians, especially primary care ones, need to pay more attention to the sexual history of their patients in order to diagnose and manage ED more frequently.
This article addresses a methodological controversy regarding the question of whether couples
should ideally be interviewed together or apart. It draws on three different studies in which
joint couple interviews were used either as the sole source of data or in combination with
individual interviews. The authors focus on the specifics and strengths of joint couple interviews,
and they argue that interviewing couples together has several advantages, such as solving the
ethical problems of anonymity and consent among interviewees, and results in the production of
rich data, including observational data. Furthermore, the authors point to the practical advantages
of conducting joint interviews with couples. In taking a relational view of the self and of what is
produced in research interviews, the authors propose to apply the concept of family display,
originally proposed by Janet Finch. It is argued that the researcher may be seen as one of many
possible audiences for this type of family practice.
Objective
To review the contemporary knowledge of local investigations in the Arab countries that were conducted to identify the magnitude of erectile dysfunction (ED) and its correlates among men in this region.MethodsMEDLINE was reviewed for English-language reports from 2000 to 2011 for Arab countries, using the terms ‘erectile dysfunction’ and ‘prevalence’.ResultsIn all, 102 articles were found to be relevant to the review. Unfortunately only a few had a high level of evidence and the remaining studies were not controlled in their design. Several local studies showed that the prevalence of ED was >40% among Arab men. Risk factors and medical comorbidities that negatively affect the cardiovascular system, endothelial function and ultimately erectile function were common in men in Arab countries. For instance, at least five Arab countries are included in the top 10 countries worldwide with a high prevalence of diabetes mellitus. The global statistics showed that other risk factors such as obesity, smoking, hypertension and dyslipidaemia are also very prevalent in Arab countries. This fact can explain the high incidence of both cardiovascular disease and ED among Arab men.ConclusionED is very prevalent among Arab men. Arab countries are among those with the highest prevalence of endothelial dysfunction risk factors, which could explain this high prevalence of ED.
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Sexual dysfunction is highly prevalent in the general population and associated with psychological distress and impaired sexual satisfaction. Psychological interventions are promising treatment options, as sexual dysfunction is frequently caused by and deteriorates because of psychological factors. However, research into the efficacy of psychological interventions is rather scarce and an up-to-date review of outcome studies is currently lacking. Therefore, we conducted a systematic review and meta-analysis of all available studies from 1980 to 2009 to examine the efficacy of psychological interventions for patients with sexual dysfunction. A total of 20 randomized controlled studies comparing a psychological intervention with a wait-list were included in the meta-analysis. The overall post-treatment effect size for symptom severity was d = 0.58 (95 % CI: 0.40 to 0.77) and for sexual satisfaction d = 0.47 (95 % CI: 0.27 to 0.70). Psychological interventions were shown to especially improve symptom severity for women with Hypoactive Sexual Desire Disorder and orgasmic disorder. Our systematic review of 14 studies comparing at least two active interventions head-to-head revealed that very few comparative studies are available with large variability in effect sizes across studies (d between -0.69 and 2.29 for symptom severity and -0.56 and 14.02 for sexual satisfaction). In conclusion, psychological interventions are effective treatment options for sexual dysfunction. However, evidence varies considerably across single disorders. Good evidence exists to date for female hypoactive sexual desire disorder and female orgasmic disorder. Further research is needed on psychological interventions for other sexual dysfunctions, their long-term and comparative effects.
Introduction. Phosphodiesterase type 5 inhibitors (PDE5) are currently the first line treatment for erectile dysfunction (ED). However, previous research shows that PDE5 treatments have high discontinuation rates. Understanding the reasons for discontinuing PDE5 will be necessary to optimize the response to treatment.
Aim. The main goals were: (i) to analyze discontinuation rate of PDE5; (ii) to identify the discontinuation predictors; and (iii) to study the reasons for discontinuation using a qualitative methodology.
Main Outcome Measures. The PDE5 discontinuation rates, predictors, and reasons for discontinuation treatment.
Methods. A total of 327 men with clinical diagnosis for ED who had been treated with PDE5 were successfully interviewed by telephone, after giving their informed consent by snail mail. Telephone interviews, concerning their ongoing treatment, were carried out using a standardized questionnaire form with quantitative and qualitative items. Participation rate was 71.8%.
Results. Of the total sample, 160 men (48.9%) had discontinued PDE5 treatment. The discontinuation rate was higher among men with diabetes (73%) and in iatrogenic group (65%), and lower in venogenic etiology (38.7%). We differentiated three groups of men who discontinued treatment (i) during the first 3 months (55.1%); (ii) between 4 and 12 months (26.9%); and (iii) after a period of 12 months (18%). Qualitative analyses revealed diverse reasons for discontinuation: non-effectiveness of PDE5 (36.8%), psychological factors (e.g., anxiety, negative emotions, fears, concerns, dysfunctional beliefs) (17.5%), erection recovery (14.4%), and concerns about the cardiovascular safety of PDE5 (8.7%) were the most common. Older men and men whose partners were involved in the treatment, were less likely to discontinue treatment.
Conclusion. Half the subjects discontinued medication. Mostly, there was a combination of factors that led to discontinuation: non-effectiveness and psychosocial factors appear to be the main reasons. Addressing those factors will allow following up with appropriate focus on relevant topics in order to improve compliance. Carvalheira AA, Pereira NM, Maroco J, and Forjaz V. Dropout in the treatment of erectile dysfunction with PDE5: A study on predictors and a qualitative analysis of reasons for discontinuation. J Sex Med 2012;9:2361–2369.
Patients suffering from erectile dysfunction (ED) feel shy to discuss this issue with their physician. Self-report questionnaires are a key instrument to break this barrier. Most of these questionnaires are in English, and their validated translations in Urdu, the official language of Pakistan, are not available.
The aim of our study is to translate, cross-culturally adapt, and perform psychometric validation of an Urdu translation of the 5-item international index of erectile function (IIEF-5).
The translation of IIEF-5 was done in Urdu and was refined through reverse translation and expert committee reviews. It was then pretested on 20 bilingual men and reviewed again to develop a final Urdu version of the questionnaire. We selected 47 patients who had been in a stable sexual relationship over the past 6 months and asked them to fill out the IIEF-5 questionnaire in both languages (Urdu and English), followed by evaluation of ED by a clinician, who was blinded to the responses of the patient to the questionnaire.
The self-report to questionnaire and independent clinical assessment were compared. Patients refilled out the questionnaire again at the end of the interview to assess test-retest consistency. These data were now analyzed statistically using descriptive statistics, Cohen's kappa, and Cronbach's alpha analysis.
The Cohen's kappa showed a very high degree of agreement between the two versions (P < 0.0001), and a high degree of internal consistency was demonstrated on Cronbach's alpha analysis ([0.882] with 95% confidence interval [0.839-0.916]). The clinical assessment of the presence and severity of ED also matched with the self-report questionnaire.
We can safely conclude that this Urdu version of IIEF-5 is a valid instrument for use in the literate population of Pakistan.
Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions of traditional gender roles and how these preserve women's subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation.
This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women's empowerment.
Describes the development of the Mental Health Inventory (MHI), a 38-item measure of psychological distress and well-being, developed for use in general populations. The MHI was fielded in 4 large samples (N = 5089) of Ss aged 13–69 yrs. One data set was used to explore the MHI's factor structure, and confirmatory factor analyses were used for cross validation. Results support a hierarchical factor model composed of a general underlying psychological distress vs well-being factor; a higher order structure defined by 2 correlated factors––Psychological Distress and Well-Being; and 5 correlated lower order factors––Anxiety, Depression, Emotional Ties, General Positive Affect, and Loss of Behavioral Emotional Control. Summated rating scales produced high internal consistency estimates and substantial stability over a 1-yr interval. Results provide strong psychometric support for a hierarchical model and scoring options ranging from 5 distinct constructs to reliance on 1 summary index. (36 ref)
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.
To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.
Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.
A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey.
Risk of experiencing sexual dysfunction as well as negative concomitant outcomes.
Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.
The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
The prevalence and correlates of erectile dysfunction (ED) in developing countries are largely unknown. Our objectives were to determine the prevalence and associated factors of ED in three countries (Pakistan, Egypt, Nigeria) that represent very different cultures. Men 35-70y of age seeking primary medical care answered a structured questionnaire adapted to reflect local cultures. Degree of ED was categorized as 'none,' 'mild,' 'moderate,' or 'complete.' The age-adjusted prevalence rates of ED among men attending primary care clinics was 57.4% in Nigeria, 63.6% in Egypt, and 80.8% in Pakistan. Older age, diabetes, peptic ulcers, prostate disease, depression-related symptoms, and caffeine consumption were independently associated with increased prevalence of ED, whereas being moderately active to very active at work (hard physical labor) and during leisure time (strenuous exercise) was associated with half the prevalence of moderate-to-complete ED. Our multicultural study demonstrates that in every country studied, high proportions of men older than age 35 have some degree of ED (57-81%). Both severity and prevalence increase consistently with age. Factors associated with ED are similar, but their distribution differs across countries.
The goal of this study was to determine potential positive effects of cognitive behavioral therapy (CBT) on Pakistani men with ED who were undergoing treatment with a PDE-5 inhibitor. We used a pre-post research design comparing men with and without adjunctive CBT. Men in the two groups were compared to determine whether CBT improved sexual function, as measured by the International Index of Erectile Function (IIEF). A total of 60 individuals diagnosed with ED completed the study. Participants were systematically assigned to one of two groups, the CBT group or the control group. The sample was drawn from outpatients referred through several hospitals in Islamabad. All men showed improvement in sexual functioning over the course of the study, though post treatment, men in the CBT group showed greater improvement on IIEF subscales of erectile functioning, orgasmic function, intercourse satisfaction and overall satisfaction than those in the control group. CBT can be considered an effective and supportive means for achieving better sexual outcomes for Pakistani men taking PDE-5 inhibitors for erectile problems.International Journal of Impotence Research advance online publication, 13 July 2017; doi:10.1038/ijir.2017.23.
Psychosexual therapy may present special challenges for the health care provider. The sensitive nature of the problem as well as the specific issues themselves may leave some therapists uncertain regarding their ability to effectively counsel individuals having such problems. This chapter provides an essential understanding of sexual issues so therapists can confidently address problems with both knowledge and strategies that help individuals and/or couples overcome sexual difficulties. The chapter gives an overview of the sexual response cycle so the therapist acquires an understanding of the salient issues surrounding sexual problems and discusses classification of sexual problems based on the Diagnostic and Statistical Manual of Mental Disorders. Then, application of standard therapeutic procedures in the treatment of sexual problems is provided, including examples of specific sexual problems in both men and women. Benefits and limitations of psychosexual therapy for the treatment of sexual problems are discussed, with attention to those that ameliorate specific sexual response problems vs those that target overall sexual relationship satisfaction. A final section considers the value of using a therapeutic strategy that combines a psychosexual approach with the use of effective pharmacological and/or biomedical options.
Erectile dysfunction is a common condition and is recognized as an important marker for underlying vascular and other disease states, A thorough evaluation with selected investigations will allow the clinician to offer a range of effective therapies and interventions. The evidence for psychologic interventions is described along with a description of other treatment options. Integrated assessment and therapeutic options allow for high success and patient satisfaction.
IntroductionErectile dysfunction (ED) is an increasing health problem that demands effective treatment. There is evidence that phosphodiesterase-5 inhibitors (PDE5-Is) and psychological intervention (PI) are effective treatment options; however, little is known about their comparative efficacy and the efficacy of combined treatments.AimThe aim of this systematic review and meta-analysis is to evaluate the comparative efficacy of PI, PDE5-Is, and their combination in the treatment of ED.Main Outcome MeasuresPrimary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient.MethodsA systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both.ResultsEight studies with a total number of 562 patients were included in the meta-analysis. The results of the included studies are inconclusive, though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone. The meta-analysis found that, overall, combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone. Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction. No differences were found between PDE5-Is and PI as stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects.Conclusions
The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients. Stronger RCTs are required to confirm this initial finding. Schmidt HM, Munder T, Gerger H, Frühauf S, and Barth J. Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: A narrative review and meta-analysis. J Sex Med **;**:**–**.
G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
While self-efficacy has been widely used to explain and treat various biobehavioral responses, few investigations have examined this concept in the context of sexual response and dysfunction. In this study, the authors constructed a measure of sexual self-efficacy, investigated whether it differentiated men with and without sexual dysfunction, and determined the utility of this construct by exploring its relation to other variables known to be related to erectile dysfunction in a sample of 60 men with erectile dysfunction and 14 functional men visiting a urology clinic. The sexual self-efficacy index differentiated men with and without erectile dysfunction, and general linear modeling showed that the index did indeed relate to other variables known to affect sexual and emotional response during a partnered sexual experience. These findings suggest that, as a unifying construct that predicts cognitive, affective, motivational, and behavioral responses, sexual self-efficacy has the potential to play an important role in the assessment of effective treatments for sexual problems.
This paper reviews empirical and theoretical publications from 1970 to 2009 on the relation between marital and sexual functioning, depression and anxiety. The link between sexual and marital functioning is well known. Marital functioning is a factor in relation with sexual dysfunctions such as hypoactive sexual desire. Sexual functioning is associated to marital satisfaction. The role of marital and sexual factors was also studied in relation with psychological distress. Satisfying marital functioning protects against the development of psychological distress but is also a factor related to depression and anxiety. The link between marital distress and depression is particularly strong. Empirical data indicate also that marital treatment may improve not only sexual and marital functioning but may also reduce symptoms of psychological distress. When depressive symptoms are associated to marital distress, research indicates that marital therapy may be considered as one of the first options of treatment to reduce both marital and psychological distress.
Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
Introduction. Honeymoon impotence can be defined as the failure to be successfully involved in sexual intercourse at the beginning of marriage, particularly in the first few nights. While its exact causes are not yet elucidated, many studies recognize this problem as related to performance anxiety.
Aim. The aim of this study was to report the outcome of management of patients with honeymoon impotence.
Methods and Main Outcome Measures. This study included 100 consecutive patients presenting to our department complaining of failed sexual intercourse since the beginning of their marriage. History taking, completion of the abridged form of the International Index of Erectile Function (IIEF-5) questionnaire, and combined intracavernous injection and stimulation and nocturnal penile tumescence monitoring were performed. Penile duplex was performed to elucidate vascular insufficiency. All psychogenic patients with erectile dysfunction (ED) were treated with sildenafil and sex therapy. All organic ED patients were treated either with sildenafil alone or combined therapy with either intracavernous prostaglandin E1 or vacuum constriction device.
Results. Seventy-four patients had psychogenic ED and 26 patients had vasculogenic ED. All psychogenic ED patients were treated successfully with sildenafil and sex therapy. Twenty-two patients with vasculogenic ED were treated successfully with sildenafil or combined therapy, while four patients needed venous surgery. Minimal side effects of all treatment modalities occurred throughout the study.
Conclusions. Management of honeymoon impotence requires profound diagnosis of its causative factors. Treating physicians in areas with high prevalence of this condition should be ready to manage this problem with vigilant systematic overture. A combined approach of sildenafil and sex therapy proved highly effective in treatment of honeymoon impotence of psychogenic origin; however, controlled studies are needed. Other patients showing functional erectile abnormalities should be treated accordingly. Shamloul R. Management of honeymoon impotence. J Sex Med 2006;3:361–366.
Introduction:
Epidemiologic studies exploring sexuality across different cultures and geographic regions are scanty, particularly from the Middle East. The Global Online Sexuality Survey (GOSS) is an Internet-based survey investigating male and female sexual function. GOSS-Arabic-Males is the Arabic version targeting males in the Middle East, exploring prevalence rate of and factors affecting erectile dysfunction and its therapeutic trends, as well as premature ejaculation, attitudes toward genital size, and contraception.
Aim:
To explore epidemiologic aspects of male sexuality through an online survey.
Main outcome measures:
Prevalence rate of erectile dysfunction, its relationship to risk factors, and therapeutic trends.
Methods:
The online survey was randomly offered to Web surfers in the Middle East.
Results:
Eight hundred four subjects completed the survey. The overall prevalence of ED was 45.1%, strongly correlating with various risk factors studied, including age, diabetes, hypertension under treatment, depression, concerns over genital size, interpersonal distress, premature ejaculation, low libido, and subjective reports of penile deviation. Adjusted to the World Standard Population, the prevalence rate for ED was 47%. Phosphodiesterase (PDE) inhibitors gave a poor response among those with low libido and interpersonal distress, emphasizing the need for proper diagnosis and psychological counseling parallel to medical treatment. Furthermore, PDE inhibitors were stigmatized with unrealistic concerns that decreased their utility to a great extent.
Conclusion:
In the study population of Arab-speaking Internet users, prevalence of erectile dysfunction and effect of risk factors have proven similar to reports from different parts of the world, though not unanimously. Premature ejaculation, low desire, concerns over penile size, and penile curvature are factors to be considered in the evaluation of ED patients. PDE inhibitors are stigmatized with false beliefs that should be addressed through mass media and counseling if this population is to take full benefit from this therapeutic option.
Background:
The area of men's sexual health has been poorly understood, particularly with reference to South Asian cultures. The belief that losing semen is detrimental to health is a concept common to both Oriental and Occidental thinking.
Aim:
To estimate the number of patients with the dhat syndrome consulting different professionals in Lahore and to examine their demographic characteristics.
Method:
Seventy health professionals of various types were approached and asked to fill in a daily record form for all patients reporting at their clinics for a period of 1 month.
Results:
A total of 1777 patients were reported to attend the outpatient clinics of health professionals of various types over a period of 1 month. The majority of patients consulted hakims for professional help. Most of the patients were single, with a mean age of 24 years and had a monthly income of less than Rs 3000.
Conclusion:
These data have important implications for patients, professionals and researchers. The alarming number of people consulting various professionals to seek help for anxiety due to semen loss highlights the fact that research into and interventions for this neglected area of men's sexual health are urgently required.
Sexual self-schemas are cognitive generalizations regarding sexual aspects of the self that represent a core component of one's sexuality. We contend that individual differences in the sexual self-view represent an important cognitive diathesis for predicting sexual difficulty or dysfunction. We illustrate the role of sexual self-schemas on sexual behavior and responsiveness in healthy female and male samples. Next, we describe how diathesis-stress models of psychopathology have been applied to the sexual arena, and discuss the critical features of clinically useful diathesis variables. Drawing from these criteria, we examine the diathetic properties of sexual self-schemas. Finally, we discuss an empirical test of the proposed diathesis-stress interaction, reviewing the role of women's sexual self-views on sexual morbidity following diagnosis and treatment for gynecologic cancer.
Treatment options for managing erectile dysfunction (ED) include medical and psychological interventions. The present study examined the effectiveness of a drug-only vs. combined treatment approach on erectile function as well as other domains of sexual function and cognition, couple intimacy and adaptation, and treatment satisfaction. Couples with ED were randomly assigned to either Viagra-only (VO) or Viagra plus sex therapy (VST). Sexual and relationship variables were measured at specific time points. Despite limitations, study findings extend previous conclusions and provide empirical support for the effectiveness and satisfaction with the combined treatment approach for treating men with ED of mixed etiology.
The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity.
A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort.
The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health-policy consequences using the recent developments in the UK as a case study.
Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population-based rates rather than rates based on clinical samples. All the projections were age-adjusted.
It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of approximately 322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America.
The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under-funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.
Erectile dysfunction, the persistent inability to attain or maintain penile erection sufficient for sexual intercourse, affects millions of men to various degrees. The majority of cases have an organic etiology, most commonly vascular disease that decreases blood flow into the penis. Regardless of the primary cause, erectile dysfunction can have a negative impact on self-esteem, quality of life and interpersonal relationships. The initial step in evaluation is a detailed medical and social history, including a review of medication use. Discussion with the patient's sexual partner may clarify exacerbating issues. The physical examination focuses on the cardiovascular, neurologic and urogenital systems. Laboratory tests are useful to screen for common etiologic factors and, when indicated, to identify hypogonadal syndromes. Appropriate evaluation of erectile dysfunction leads to accurate advice, management and referral of patients with erectile dysfunction.
Erection is basically a spinal reflex that can be initiated by recruitment of penile afferents, but also by visual, olfactory, and imaginary stimuli. The reflex involves both autonomic and somatic efferents and is modulated by supraspinal influences. Several central transmitters involved in the erectile control have been identified. Dopamine, acetylcholine, nitric oxide (NO), and peptides, such as oxytocin and adrenocorticotropic/alpha-melanocyte-stimulating hormone, seem to have a facilitatory role, whereas serotonin may be either facilitatory or inhibitory, and enkephalins are inhibitory. Peripherally, the balance between contractant and relaxant factors controls the degree of contraction of the smooth muscle of the corpora cavernosa and determines the functional state of the penis. Noradrenaline contracts both corpus cavernosum and penile vessels via stimulation of alpha(1)-adrenoceptors. Neurogenic NO is considered the most important factor for relaxation of penile vessels and corpus cavernosum. The role of other mediators released from nerves or endothelium has not been definitely established. Erectile dysfunction (ED) may be due to inability of penile smooth muscles to relax. This inability can have multiple causes. However, patients with ED respond well to the pharmacological treatments that are currently available. The drugs used are able to substitute, partially or completely, the malfunctioning endogenous mechanisms that control penile erection. Most drugs have a direct action on penile tissue facilitating penile smooth muscle relaxation, including prostaglandin E(1), NO donors, phosphodiesterase inhibitors, and alpha-adrenoceptor antagonists. Dopamine receptors in central nervous centers participating in the initiation of erection have been targeted for the treatment of ED. Apomorphine, administered sublingually, is the first of such drugs.
Recent research on the treatment of erectile dysfunction (ED) has focused on medical interventions, in particular oral medications. The current study examined the effectiveness of an internet-based psychological intervention for this condition. In total, 31 men (12 in treatment group, 19 in control group) completed the program. The results demonstrated that men who completed the program reported improved erectile functioning and sexual relationship satisfaction and quality. The implications of these findings for the treatment of ED are discussed.
Sexual satisfaction is linked to life satisfaction, and erectile dysfunction (ED) may lead to an impaired quality of life (QOL).
Our goal was to evaluate the QOL among Brazilian patients with ED, before and after three kinds of treatment.
Men aged 25-55 years, with a diagnosis of psychogenic or mixed ED, according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases, 10th edition, and the Standard Practice in Sexual Medicine, were randomly assigned to three treatment groups: counseling, sildenafil, and sildenafil plus counseling. At baseline each group had 40 patients. Sildenafil was provided in 50 mg that could be adjusted to 100 mg. The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months. Counseling was provided in group sessions that took place once a week. They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient (MSQ) and the Sexual Health Inventory for Men (SHIM).
The correlation between the patients' MSQ score and scores on the SHIM.
One hundred seventeen patients were enrolled. The three groups were similar according to age, marital status, mean time of ED, and ED severity and etiology. At baseline, MSQ and SHIM total scores were not different among the three groups. MSQ scores increased from 41.2 +/- 15.3, 38.7 +/- 18.0, and 46.8 +/- 17.0 to 48.5 +/- 15.3, 63.8 +/- 21.6, and 70.0 +/- 17.3 after counseling, sildenafil, and sildenafil plus counseling, respectively (P < 0.05). SHIM scores also increased significantly (9.6 +/- 4.1, 9.7 +/- 4.1, and 10.2 +/- 3.9 to 12.1 +/- 3.9, 16.7 +/- 5.6, and 17.7 +/- 4.5 after counseling, sildenafil, and sildenafil plus counseling, respectively) (P < 0.05). There were no serious adverse events related to sildenafil, and no patient was withdrawn from the study because of an adverse event.
The three treatments were significantly efficient, and the best treatment was sildenafil associated with counseling.