Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction

Abstract

Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners. Even when physiologically effective, long-term adherence to ED treatments is poor. We review here the implication of having patients’ partners involved in ED treatment, starting with treatment selection. We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, i.e., conceptually linking the aid to the sexual pleasure that the partner provides. We hypothesize that this erotic association should enhance the sexual aid’s effectiveness and might potentially help improve long-term adherence. The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED. Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life. The aids discussed include external penile prostheses, penile sleeves, and penile support devices. These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED. External penile prostheses can be personalized so they match in size and shape a man’s normal full erection. Penile sleeves can similarly be customized with a lumen that fits best a patient’s penis for optimal tactile stimulation. We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED. Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery. Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments. The most commonly promoted non-medical ED aid offered to patients is the vacuum erection device. We discuss how erections achieved with the vacuum erection device have a “hinge effect”, that is an underappreciated barrier to the effectiveness of the erection. With a hinged erection, the penis points downward rather than upward. We show how the normal kinematics of the penis during coitus is not strictly linear (i.e., not uniaxial; not just in-and-out), and is impeded by hinging. Positional adjustment, such as the receptive partner being on top, may help overcome this problem for some couples. Lastly, we suggest that, in the case where ED can be anticipated from a pending medical treatment, such as a prostatectomy, pre-habilitative approaches may potentially improve adherence to sexual aid use in the long-term. In conclusion, non-pharmacological and non-surgical options for sexual recovery are available. Scientific studies on the effectiveness of these interventions in restoring satisfying sex are warranted.

Associations Between Altered Cerebral Activity Patterns and Psychosocial Disorders in Patients With Psychogenic Erectile Dysfunction: A Mediation Analysis of fMRI

“…This contributed to the understanding of the mechanisms behind the correlations between abnormal brain functional synchronization and impaired erectile function, and further enhanced our knowledge of the critical roles played by psychosocial disorders in the pathogenesis of pED. To some extent, this finding implied the rationale and feasibility of modulating abnormal brain activity and regulating abnormal psychosocial status to improve clinical symptoms of pED, which has been tentatively demonstrated in several clinical studies (57)(58)(59).…”

Contemporary Vistas in Geriatric Sexuality

“…Mostly penile rigidity remains adequate for vaginal intercourse, but couples may require extended foreplay, manual stimulation, or try different positions to achieve full penile erection for penetration. 11…”

Recent advances in the understanding and management of erectile dysfunction

“…Many risk factors for ED exist including age, coronary artery disease, obesity, smoking, depression, hypertension, prior pelvic surgery, and spinal cord injuries as well as other psychological variables 3 . Sexual health and erectile quality are key components to not only an individual’s quality of life but also their partner’s mental, emotional, and physical well-being 4 . Along those lines, many seek support as they navigate their way through the multiple treatment options.…”