Role of psychosexual counseling as an adjuvant to pharmacotherapy in the treatment of erectile dysfunction.

Abstract

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.9-12