Mental health articles

Treatment of erectile dysfunction

Anxiety reduction and desensitization

The classic treatment programme for erectile failure, known as sensate focusing, was developed by Masters and Johnson. It involves a structured approach, designed to take the stress out of the sexual act. It begins with the couple learning to touch each other in pleasurable ways, but with a mandate not to touch each other’s genitals. Their goal is to enjoy the intimacy of touch, not to give or receive sexual pleasure. Once couples are comfortable with non-genital sensate focusing, they are directed to gradually make genital contact and to give and receive pleasure doing so. At this time, they are still mandated not to attempt intercourse, nor for the male to try to achieve or maintain an erection (although this typically occurs). Finally, when the couple are comfortable with this level of intimacy, they may progress to full intercourse. This is a frequently applied intervention; although there are relatively few studies of its effectiveness, it is generally considered to be highly effective.

Cognitive techniques

There are relatively few formal assessments of cognitive interventions in the treatment of erectile failure, although Goldman and Carroll reported the outcomes of a number of workshops in which participants were given appropriate sexual information and inappropriate cognitive concerns were challenged. Participants showed significant changes in knowledge and attitudes towards sex, and reported increased sexual frequency and satisfaction in the short term; no long-term data were reported.

Interpersonal interventions

Hawton et al. reported that the most important predictor of outcome following a programme of sensate focusing and graduated stimulation techniques was the couples’ ratings of marital communication before treatment. Three domains are the main foci of interpersonal interventions: status and dominance

issues intimacy and trust

loss of sexual attraction.

Each of these may be more or less salient in the lifetime of a sexual relationship. Status and dominance issues may be salient when one partner loses a job or achieves promotion; intimacy or trust issues may be salient following an affair, while loss of sexual attraction may follow weight gain or some other physical or psychological changes. Following an intervention addressing these factors, Hawton and colleagues reported that 70 per cent of couples reported a positive outcome.

Medical approaches

Perhaps the best-known pharmacological treatment for erectile failure is sildenal, more popularly known as Viagra. This works on the smooth muscle of the penis. It is an inhibitor of the enzyme phosphodiesterase type 5 (PDE5) which normally breaks down cyclic guanosine monophosphate (cGMP), a chemical that brings about smooth muscle relaxation, and maintains the erectile response. It is generally effective in treating erectile dysfunction, whatever the cause. Goldstein et al., for example, reported that 70 per cent of men treated with Viagra reported improvements in the quality and frequency of erections; 70 per cent of attempts at intercourse were successful, in comparison with 22 per cent of attempts by those treated with placebo. PDE5 is predominantly found in the penis. However, it is also found in other areas of the body. As a consequence, about 16 per cent of users experience headaches, 10 per cent experience facial flushing, with other effects such as gastrointestinal upset and alterations in colour vision being somewhat rarer. One of the more dramatic side-effects was thought to be the onset of a heart attack, but this is now thought to be a result of exercise, not the drug (Holmes 2000). One of the benefi ts of Viagra is that it enhances the sexual response rather than initiates it. Erection therefore follows sexual stimulation, and does not immediately follow taking the drug, as is the case in some alternatives. Erection may also be achieved by vacuum pumps, direct injection of drugs into the penis and the use of prostheses. Each method has achieved some success, and many continue to be used, but less so in the light of the development of Viagra and similar drugs (Ralph and McNicholas 2000).

Tags: Ed, treatments