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Current Sexual Health Reports
Published in: Current Sexual Health Reports 2/2014

01-06-2014 | INTEGRATING THE PSYCHOSOCIAL (B McCARTHY, RT SEGRAVES, AND AH CLAYTON, SECTION EDITORS)

Integrative Approaches to the Treatment of Erectile Dysfunction

Authors: Michael D. Berry, Philip D. Berry

Published in: Current Sexual Health Reports | Issue 2/2014

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Abstract

Integrative management of erectile disorder (ED) includes focused attention on both medical and psychosocial factors. Recent changes to the psychiatric diagnostic criteria for ED reflect an increasingly quantitative nosology and a shift towards an integrative view of biopsychosocial factors. This article outlines recent research that provides evidence for involving the patient’s partner, where possible, in a patient-centered model for the management of ED. Diagnostic challenges, including possible deficits in physician training and comfort in dealing with ED, are identified, and key elements of an integrative sexual status examination are described. Process-of-care standards for evidence-based practice serve to highlight the importance of integrative treatment. A treatment algorithm—based on these evidence-based guidelines and recent research on integrative and combinative practice—is provided, followed by a discussion of areas of focus for future research.
Literature
1.••
Montorsi F et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2010;7(11):3572–88. These are the summary guidelines for evidence-based treatment of ED, based on the International Consultation on Sexual and Erectile Dysfunction.PubMedCrossRef
2.••
Montorsi F et al., editors. Sexual medicine: Sexual dysfunction in Men and woman, 3rd international consultation on sexual and erectile dysfunction co-sponsored by the world health organization (WHO), international society of sexual and impotence research (ISIR) and societe internationale D'Urologie (SIU). Paris: Health Publications Ltd; 2010. These are the full guidelines for evidence-based treatment of ED.
3.
Lue TF et al., editors. Sexual medicine: Sexual dysfunction in Men and woman, 2nd international consultation on sexual and erectile dysfunction co-sponsored by the world health organization (WHO), international society of sexual and impotence research (ISIR) and societe internationale D'Urologie (SIU). Paris: Health Publications Ltd; 2004.
4.
Toates F. An integrative theoretical framework for understanding sexual motivation, arousal, and behavior. J Sex Res. 2009;46(2–3):168–93.PubMedCrossRef
5.•
Simopoulos EF, Trinidad AC. Male erectile dysfunction: Integrating psychopharmacology and psychotherapy. Gen Hosp Psychiatry. 2013;35(1):33–8. This article draws on recent research from the urologic and psychiatric literature to outline integrative treatment strategies that can be applied by a range of health professionals.
6.
7.
Hertlein KM, Weeks GR. Toward a new paradigm in Sex therapy. J Fam Psychother. 2009;20(2–3):112–28.CrossRef
8.
Banner LL, Anderson RU. Integrated sildenafil and cognitive-behavior sex therapy for psychogenic erectile dysfunction: A pilot study. J Sex Med. 2007;4(4 Pt 2):1117–25.PubMedCrossRef
9.
Perelman MA. Combination therapy for sexual dysfunction: Integrating sex therapy and pharmacotherapy. In: Balon R, Segraves R, editors. Handbook of sexual dysfunction. New York: Taylor and Francis; 2005. p. 13–41.
10.
Rosen RC. Erectile dysfunction: Integration of medical and psychological approaches. In: Leiblum SR, editor. Principles and practice of Sex therapy. New York: The Guilford Press; 2007. p. 277–310.
11.
Althof S, Rosen RC. Combining medical and psychological interventions for the treatment of erectile dysfunction. In: Levine SB, Risen CB, Althof S, editors. Handbook of clinical sexuality for mental health professionals. 2nd ed. New York: Routledge; 2010. p. 251–66.
12.
Riley A. Integrated approaches to therapy. Sexual and Marital Therapy. 1998;13(3):229–32.CrossRef
13.
14.
Berry MD, Berry PD (2013) Contemporary treatment of sexual dysfunction: Reexamining the biopsychosocial model. J Sex Med
15.
Assalian P. Psychological and interpersonal dimensions of sexual function and dysfunction. Arab Journal of Urology. 2013;11(3):217–21.CrossRef
16.
Althof SE. Therapeutic weaving: The integration of treatment techniques. In: Levine SB, editor. Handbook of clinical sexuality for mental health professionals. New York: Brunner-Routledge; 2003. p. 359–76.
17.
Althof SE. Sexual therapy in the age of pharmacotherapy. Annual Review of Sex Research. 2006;17:116–31.
18.
Bruzziches R et al. An update on pharmacological treatment of erectile dysfunction with phosphodiesterase type 5 inhibitors. Expert Opin Pharmacother. 2013;14(10):1333–44.PubMedCrossRef
19.
Ljunggren C et al. Giving patients with erectile dysfunction the opportunit to try all three available phosphodiesterase type 5 inhibitors. Journal of Sexual Medicine. 2008;5(2):469–75.PubMedCrossRef
20.
Klotz T et al. Why do patients with erectile dysfunction abandon effective therapy with sildenafil (Viagra (R))? Int J Impot Res. 2005;17(1):2–4.PubMedCrossRef
21.
Jiann BP et al. Compliance of sildenafil treatment for erectile dysfunction and factors affecting it. Int J Impot Res. 2006;18(2):146–9.PubMedCrossRef
22.
Salonia A et al. Original research—ejaculatory disorders: Acceptance of and discontinuation rate from paroxetine treatment in patients with lifelong premature ejaculation. Journal of Sexual Medicine. 2009;6(10):2868–77.PubMedCrossRef
23.
Carvalheira AA et al. Dropout in the treatment of erectile dysfunction with PDE5: A study on predictors and a qualitative analysis of reasons for discontinuation. Journal of Sexual Medicine. 2012;9(9):2361–9.PubMedCrossRef
24.
25.•
Conaglen HM, Conaglen JV. Couples' reasons for adherence to, or discontinuation of, PDE Type 5 inhibitors for men with erectile dysfunction at 12 to 24-month follow-up after a 6-month free trial. Journal of Sexual Medicine. 2012;9(3):857–65. An innovative study exploring the reasons for couples’ discontinuance of PDE5i treatment.PubMedCrossRef
26.
Althof SE, Needle RB. Psychological factors associated with male sexual dysfunction: Screening and treatment for the urologist. Urol Clin North Am. 2011;38(2):141–6.PubMedCrossRef
27.
Perelman MA. Psychosocial evaluation and combination treatment of men with erectile dysfunction. Urol Clin North Am. 2005;32(4):431–45. vi.PubMedCrossRef
28.
Bettocchi C et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. Journal of Sexual Medicine. 2010;7(1):304–9.PubMedCrossRef
29.
Levine LA, Benson J, Hoover C. Inflatable penile prosthesis placement in men with Peyronie's disease and drug-resistant erectile dysfunction: A single-center study. Journal of Sexual Medicine. 2010;7(11):3775–83.PubMedCrossRef
30.
Vakalopoulos I et al. High patient satisfaction after inflatable penile prostheses implantation correlates with female partner satisfaction. Journal of Sexual Medicine. 2013;10(11):2774–81.PubMedCrossRef
31.
Kramer AC, Schweber A. Patient expectations prior to coloplast titan penile prosthesis implant predicts postoperative satisfaction. Journal of Sexual Medicine. 2010;7(6):2261–6.PubMedCrossRef
32.
Mulhall JP et al. Serial assessment of efficacy and satisfaction profiles following penile prosthesis surgery. J Urol. 2003;169(4):1429–33.PubMed
33.
Levine SB. GUEST EDITORIAL: The first principle of clinical sexuality. Journal of Sexual Medicine. 2007;4(4i):853–4.PubMedCrossRef
34.
Levine SB, Scott DL. Sexual education for psychiatric residents. Academic Psychiatry. 2010;34(5):349–52.PubMedCrossRef
35.
Althof S, Wieder M. Psychotherapy for erectile dysfunction: Now more relevant than ever. Endocrine. 2004;23(2–3):131–4.PubMedCrossRef
36.
Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med. 2008;5(11):2562–74.PubMedCrossRef
37.
Association AP (2013) Diagnostic and statistical manual of mental disorders, Washington, DC
38.
Association AP (2000) Diagnostic and statistical manual of mental disorders. 4th ed., Text Revision ed, Washington, DC
39.
Segraves RT. Considerations for diagnostic criteria for erectile dysfunction in DSM V. J Sex Med. 2010;7(2 Pt 1):654–60.PubMedCrossRef
40.
Wincze JP, Carey MP. Sexual dysfunction: A guide for assessment and treatment. 2nd ed. New York: The Guilford Press; 2001.
41.
Martin S et al. Clinical and biopsychosocial determinants of sexual dysfunction in middle-aged and older Australian men. J Sex Med. 2012;9(8):2093–103.PubMedCrossRef
42.
Perelman MA. Erectile dysfunction and depression: Screening and treatment. Urol Clin North Am. 2011;38(2):125–39.PubMedCrossRef
43.
Althof SE et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2005;2(6):793–800.PubMedCrossRef
44.
Lue TF et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1(1):6–23.PubMedCrossRef
45.
Hatzimouratidis K et al. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804–14.PubMed
46.
Adamis S et al. The role of the psychiatric approach for the treatment of several urologic diseases. Current Urology. 2010;4(3):113–8.CrossRef
47.
Chao J-K, Hwang TIS. Contemporary management of erectile dysfunction. Urological Science. 2013;24(2):35–40.CrossRef
48.
El-Sakka AI, Shamloul R, Yassin AA. Erectile dysfunction, cardiovascular diseases and depression: Interaction of therapy. Expert Opin Pharmacother. 2009;10(13):2107–17.PubMedCrossRef
49.
McVary KT, editor. Contemporary treatment of erectile dysfunction: A clinical guide (Contemporary endocrinology). New York: Humana Press; 2010.
50.
Hatzichristou D et al. Clinical evaluation and management strategy for sexual dysfunction in men and women. J Sex Med. 2004;1(1):49–57.PubMedCrossRef
51.
Gooren L. How to optimise treatment of erectile dysfunction above and beyond the beneficial effects of a phosphodiesterase type 5 inhibitor. Journal of Men's Health. 2008;5(2):163–70.CrossRef
52.
Berookhim BM, Bar-Chama N. Medical implications of erectile dysfunction. Med Clin North Am. 2011;95(1):213–21.PubMedCrossRef
53.
Goldstein I. The mutually reinforcing triad of depressive symptoms, cardiovascular disease, and erectile dysfunction. Am J Cardiol. 2000;86(2A):41F–5F.PubMedCrossRef
54.
El-Sakka AI. Erectile dysfunction, depression, and ischemic heart disease: Does the existence of one component of this triad necessitate inquiring the other two? J Sex Med. 2011;8(4):937–40. quiz 941.PubMedCrossRef
55.
Laumann EO, Paik A, Rosen RC. The epidemiology of erectile dysfunction: Results from the national health and social life survey. Int J Impot Res. 1999;11(1):S60–4.PubMedCrossRef
56.
57.
58.
Waldinger MD. Not medical solutions, but overmedicalization by pharmaceutical company policies endanger both sexological care, science, and sexual medicine. A commentary. Journal of Sex & Marital Therapy. 2008;34(3):179–83.CrossRef
59.
McCarthy BW, McDonald DO. Psychobiosocial versus biomedical models of treatment: Semantics or substance. Sexual and Relationship Therapy. 2009;24(1):30–7.CrossRef
60.
Meuleman EJ et al. Diagnostic tests for male erectile dysfunction revisited. Committee consensus report of the international consultation in sexual medicine. J Sex Med. 2010;7(7):2375–81.PubMed
61.
Tsimitsiou Z et al. Predictors of physicians' involvement in addressing sexual health issues. Journal of Sexual Medicine. 2006;3(4):583–8.CrossRef
62.•
Dyer K, das Nair R (2012) Why don't healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United Kingdom. J Sex Med. Though localized to the UK, this systematic review provides evidence on some of the main factors involved in the low levels of attention to sexual health factors amongst medical professionals.
63.
Athanadiasis L et al. Educating physicians to treat erectile dysfunction patients: Development and evaluation of a course on communication and management strategies. Journal of Sexual Medicine. 2006;3:47–55.CrossRef
64.
Foley S, Wittmann D, Balon R. A multidisciplinary approach to sexual dysfunction in medical education. Acad Psychiatry. 2010;34(5):386–9.PubMedCrossRef
65.
Seftel AD. Medical solutions to sexual problems continue to make sexological care and science essential to the successful treatment of male ED. J Sex Marital Ther. 2007;33(5):467–8.PubMedCrossRef
66.
Hartmann U, Burkart M. Erectile dysfunctions in patient–physician communication: Optimized strategies for addressing sexual issues and the benefit of using a patient questionnaire. Journal of Sexual Medicine. 2007;4(1):38–46.PubMedCrossRef
67.
Sachs BD. Contextual approaches to the physiology and classification of erectile function, erectile dysfunction, and sexual arousal. Neurosci Biobehav Rev. 2000;24(5):541–60.PubMedCrossRef
68.
McCabe M et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2010;7(1 Pt 2):327–36.PubMedCrossRef
69.
70.
Hawton K. Sex therapy: A practical guide. Northvale: Aronson; 1985.
71.
Burnett AL, Hellstrom WJG. Management of erectile dysfunction: Great progress, greater promise. J Androl. 2012;33(6):1107–10.PubMedCrossRef
72.
Melnik T et al. Satisfaction with the treatment, confidence and ‘naturalness’ in engaging in sexual activity in men with psychogenic erectile dysfunction: Preliminary results of a randomized controlled trial of three therapeutic approaches. BJU Int. 2012;109(8):1213–9.PubMedCrossRef
73.
Grellet L, Faix A. What exactly are we trying to cure when we treat someone for erectile dysfunction? Sexologies. 2011;20(1):8–11.CrossRef
74.
McCarthy BW, Fucito LM. Integrating medication, realistic expectations, and therapeutic interventions in the treatment of male sexual dysfunction. J Sex Marital Ther. 2005;31(4):319–28.PubMedCrossRef
75.
76.
Metz M, McCarthy BW. The 'good-enough sex' model for couple sexual satisfaction. Sexual and Relationship Therapy. 2007;22(3):351–62.CrossRef
77.
Boisaubin EV, McCullough LB. Prescribing viagra in an ethically responsible fashion. Journal of Medicine & Philosophy. 2004;29(6):739–49.CrossRef
78.
Levine SB. Marital sexual dysfunction: Erectile dysfunction. Ann Intern Med. 1976;85(3):342–50.CrossRef
79.
Hakim J et al. Quality control in the screening of erectile dysfunction—results of a survey. Urology. 2002;60(1):125–9.PubMedCrossRef
80.
Kaplan HS, Perelman MA. The physician and the treatment of sexual dysfunction. In: Usdin G, Lewis J, editors. Psychiatry in general medical practice. New York: McGraw-Hill; 1979.
81.•
Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153–65. A clear and applicable overview of ED management strategies, based on current research..PubMedCrossRef
82.
Miner M, Rajfer J (2012) Primary care evaluation and treatment of erectile dysfunction. In: Shoskes DA (ed )Urological men’s health, Humana Press. p. 105–119.
83.
Metz M, McCarthy BW. The good enough sex (GES) model: Perspectives and clinical applications. In: Kleinplatz P, editor. New directions in sex therapy. 2nd ed. New York: Routledge; 2012. p. 231–52.
84.
Wittmann D, Foley S, Balon R. A biopsychosocial approach to sexual recovery after prostate cancer surgery: The role of grief and mourning. Journal of Sex & Marital Therapy. 2011;37(2):130–44.CrossRef
85.
Segraves RT. Pharmacologic management of sexual dysfunction: Benefits and limitations. CNS Spectr. 2003;8(3):225–9.PubMed
86.
Shorter E. The history of the biopsychosocial model and the education of health professionals. In: White P, editor. Biopsychosocial medicine: An integrated approach to understanding illness. Oxford: Oxford University Press; 2005.
87.
Carvalho J, Nobre P. Biopsychosocial determinants of men's sexual desire: Testing an integrative model. J Sex Med. 2011;8(3):754–63.PubMedCrossRef
88.
Metz M, McCarthy BW. Erectile dysfunction: An integrative, biopsychosocial approach to evaluation, treatment, and relapse prevention. Contemp Sex. 2005;39(5):i–viii.
89.
Perelman MA. Sex coaching for physicians: Combination treatment for patient and partner. Int J Impot Res. 2003;15(5):S67–74.PubMedCrossRef
90.
Zamboni. The role of sex therapists in treating erectile dysfunction: Working toward multidisciplinary treatment with physicians. Current sexual health reports. 2006;3(4):154–7.CrossRef
91.
92.
Rosen R et al. The process of care model for evaluation and treatment of erectile dysfunction. Int J Impot Res. 1999;11(2):59–70.CrossRef
93.
Albersen M et al. Evaluation and treatment of erectile dysfunction. Med Clin North Am. 2011;95(1):201–12.PubMedCrossRef
94.••
Tan HM, Tong SF, Ho CCK. Men's health: Sexual dysfunction, physical, and psychological health—is there a link? Journal of Sexual Medicine. 2012;9(3):663–71. Biopsychosocially oriented research suggesting a strong link among sexual functioning, biological, and psychological factors.PubMedCrossRef
95.
Wespes E et al. Male sexual dysfunction: Erectile dysfunction and premature ejaculation [full treatment guidelines]. 2010.
96.
Walker LM, Robinson JW. A description of heterosexual couples' sexual adjustment to androgen deprivation therapy for prostate cancer. Psycho-Oncology. 2011;20(8):880–8.PubMedCrossRef
97.
Rosing D et al. Male sexual dysfunction: Diagnosis and treatment from a sexological and interdisciplinary perspective. Deutsches Arzteblatt International. 2009;106(50):821–8.PubMedCentralPubMed
98.
Hassan A et al. Couple satisfaction to different therapeutic modalities for organic erectile dysfunction. Journal of Sexual Medicine. 2009;5(10):2381–91.CrossRef
99.
Dean J et al. Partner satisfaction and successful treatment outcomes for men with erectile dysfunction (ED). Eur Urol Suppl. 2006;5(13):779–85.CrossRef
100.
Chevret-Measson M et al. Improvement in quality of sexual life in female partners of men with erectile dysfunction treated with sildenafil citrate: Findings of the index of sexual life (ISL) in a couple study. J Sex Med. 2009;6(3):761–9.PubMedCrossRef
101.
Dean J et al. Effective erectile dysfunction (ED) treatment enables men to enjoy better sex: The importance of erection hardness, psychological well-being, and partner satisfaction. Eur Urol Suppl. 2006;5(13):761–6.CrossRef
102.
Fisher WA et al. ORIGINAL RESEARCH—COUPLES' SEXUAL DYSFUNCTIONS: Erectile dysfunction (ED) is a shared sexual concern of couples II: Association of female partner characteristics with male partner ED treatment seeking and phosphodiesterase type 5 inhibitor utilization. Journal of Sexual Medicine. 2009;6(11):3111–24.PubMedCrossRef
103.
Dean J et al. Integrating partners into erectile dysfunction treatment: Improving the sexual experience for the couple. Int J Clin Pract. 2008;62(1):127–33.PubMedCrossRef
104.•
Kukula KC, Jackowich RA, and Wassersug RJ (2013) Eroticization as a factor influencing erectile dysfunction treatment effectiveness. Int J Impot Res. This innovative research provides a framework for including the treatment of ED, which focuses on cognitive factors (i.e., eroticization) in the integrative use of pharmacological treatment.
105.
McCarthy BW. Relapse prevention strategies and techniques with erectile dysfunction. J Sex Marital Ther. 2001;27(1):1–8.PubMedCrossRef
106.
Aubin S et al. Comparing sildenafil alone vs. sildenafil plus brief couple sex therapy on erectile dysfunction and couple's sexual and marital quality of life: A pilot study. J Sex Marital Ther. 2009;35:122–43.PubMedCrossRef
107.
Eardley I et al. Pharmacotherapy for erectile dysfunction. Journal of Sexual Medicine. 2010;7(1):524–40.PubMedCrossRef
Metadata
Title
Integrative Approaches to the Treatment of Erectile Dysfunction
Authors
Michael D. Berry
Philip D. Berry
Publication date
01-06-2014
Publisher
Springer US
Published in
Current Sexual Health Reports / Issue 2/2014
Print ISSN: 1548-3584
Electronic ISSN: 1548-3592
DOI
https://doi.org/10.1007/s11930-014-0012-z

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