Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychogenic Erectile Dysfunction: A Pilot Study

Abstract

Introduction Men with psychogenic erectile dysfunction (ED) present a challenge to physicians. Treatment with pharmacological agents alone does not address the complexities of the causative or resulting psychological issues. Aim To evaluate the effectiveness of an integrative treatment protocol (ITP) with sildenafil and cognitive-behavior sex therapy (CBST) compared with sildenafil alone for men with psychogenic ED. Main Outcome Measures Change from baseline on the International Index of Erectile Function (IIEF) in the domains of erectile function and sexual satisfaction to demonstrate improved sexual functioning and confidence. Methods Men with psychogenic ED and female partners were randomized to receive either sildenafil alone or an ITP with sildenafil and CBST for the first 4 weeks. In the last 4 weeks, couples in the sildenafil group added CBST sessions to their regimen; patients in the ITP group continued the combined therapy. The IIEF questionnaire was used to compare erectile function and overall satisfaction serially at pretreatment, 4, and 8 weeks. Couples who met the success criteria in both domains after the first 4 weeks received no further treatment. Results Fifty-three couples constituted the study population. After the first 4 weeks of sildenafil and ITP, 48% of men met criteria for success on erectile function and 65.5% for satisfaction compared to men on sildenafil alone with 29% and 37.5% success rates, respectively. After the last 4 weeks, integration of CBST with sildenafil resulted in a 58% success rate for erectile function which was comparable to the 66% rate for the initial drug/ITP group; satisfaction rates for men were 45% and 75%, respectively. Conclusions CBST was shown to have a positive influence when used throughout the entire 8 weeks of the ITP or added to the sildenafil in the last 4 weeks. Although patients in both treatment regimens had significant improvements in the IIEF domain scores confirming efficacy of sildenafil, those in the CBST and drug regimen achieved higher rates of clinical success within the first 4 weeks of therapy.

Comparing Sildenafil Alone Vs. Sildenafil Plus Brief Couple Sex Therapy on Erectile Dysfunction and Couples' Sexual and Marital Quality of Life: A Pilot Study

“…These included less sexual shoulds for men and women and more lubrication. With respect to the couple relationship domain, our results were in accordance with other study findings by showing an absence of significant treatment response on couple emotional intimacy and adaptation (Bach et al, 2004;Banner & Anderson, 2007;Phelps et al, 2004;Rosen et al, 2006). One possible explanation may relate to couple adaptation ratings well above the cut-off scores before entering treatment, indicating high levels of functioning and lack of relationship disturbance (see DAS in Table 2).…”

“…Treatment gains specific to sexual function and satisfaction for both partners were also consistent with previous clinical outcome studies using either Sildenafil alone or Sildenafil combined with sex therapy Bach et al, 2004;Banner & Anderson, 2007;Cayan et al, 2004;Fisher et al, 2005;Giuliano, 2001;Goldstein et al, 1998;Rosen et al, 2006).…”

“…However, the ITP/CBST showed higher percentage rates of men meeting the study criteria's clinical success for both erectile function and sexual satisfaction within the first 4 weeks of treatment. The ITP/CBST treatment approach was thus shown to be effective throughout the entire 8 weeks of treatment as well as when it was added to Sildenafil (Banner & Anderson, 2007).…”

Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction

“…Face-to-face psychological treatments for ED have also been associated with incomplete reversal of sexual dysfunction. 2,3,[19][20][21][22] Further, given that men who completed Rekindle had, on average, been experiencing ED for a significant length of time (M ¼ 5.19 years), it was unrealistic to expect restored sexual function after only 10 weeks of treatment. Improvements in sexual relationship satisfaction and sexual relationship quality, but not general relationship satisfaction were, significantly greater among men completing Rekindle compared with those received no treatment.…”

Combination therapy for erectile dysfunction: an update review

“…Results show at least a partial response to the combined treatment in regards to erectile function and overall sexual satisfaction. 48,49 . John et al 50 conducted the only known objective study of combination therapy with intraurethral PGE1 plus VED.…”