Treatment of Erection Problems (Part 2)

Erectile Dysfunction – more on treatment

Here we continue to look at the effectiveness of various treatment regimes as differentiated by the severity of a man’s erection problems.

Primary vs. Secondary Erectile Dysfunction

Men who had primary erection problems before the study were less likely than those with secondary erection problems to experience better and successful intercourse. But for men in both groups of severity, group therapy produced better results than most other therapies.

Kockott conducted a study to assess the effectiveness in therapy of treatment by systematic desensitization of erection problems. Therapeutic changes and outcomes were investigated on three levels: behavioral, physiological and subjective levels. There were no significant differences recorded among the desensitization group compared to the standard medical treatment group in outcome persistence of ED.

Group Interventions vs. Drug Therapy (Group Therapy vs. Sildenafil Citrate)

One study by Melnik and Abdo directly compared group therapy and Viagra – also known as Sildenafil citrate – in the treatment of erectile dysfunction. This investigation discovered significant differences between group therapy and the Viagra group. The recorded rate of IIEF was better in the group therapy. There was also notable and significant difference at the three months follow-up. The recorded rate of dropout was rather higher in the Sildenafil group, since four of six dropouts were originally in this group.

The effectiveness of sex therapy compared to vacuum devices

Wytie investigated a group of 45 men who had been diagnosed as having erectile dysfunction with a predominantly psychological origin.

25 of these men and their partners received both sexual psychotherapy and a vacuum constriction device, which has also been called a vacuum erectile device. The other 20 men and their partners received only the psychotherapy treatment. The results demonstrated that there was no difference in effectiveness in the two treatment methodologies, either at three weeks of treatment or six weeks of treatment.

This study appears to be one of the few conducted to establish the effectiveness of psychological interventions. But the fact is, reliable data was scarce at the time the research was done. Out of 2000 studies which were reviewed to put the paper together, there were a mere 11 which were actually written well enough to be re-analyzed and presented in the study currently under review. Problems included the lack of control group, small sample sizes, and conclusions which were unjustified. This was ether on the basis of the methodology, or because the sample size was too small to justify the conclusions.

Nevertheless, based on the papers which were adequate for the purpose of this review, some clear conclusions did emerge. First of all, group therapy does appear to be an effective methodology for treating erectile issues.

And group therapy is more effective than individual therapy. This kind of therapy is an established method of treatment. It is based on the assumption that sexual dysfunction has its origin in many different causes. These can be treated in various ways including education, intimacy assignments at home, psychotherapy, and counseling.

There was no relationship between the severity of erectile issues that a man was experiencing and the type of partnership or the man’s age. It’s generally assumed that the severity of a man’s erection problems is related to the type of partner he has, the quality of the relationship, and his age, but there was not sufficient supporting evidence to back up these conclusions in a definitive manner.

It’s also worth noting that what have been described as “psychoeducational” interventions did not produce statistically significant results between pre-and post treatment scores. Such lack of information in studies investigating the origin and treatment of erection problems is not unusual. (This study is one of the few that has, despite its limited scope, provided some indication of the most effective treatment method.)

One of the most interesting findings is that systematic desensitization did not show much difference in effectiveness to conventional group therapy as far as the persistence of erection problems was concerned.

That’s very interesting because it’s generally assumed that the treatment of sexual dysfunction requires careful assessment of the man experiencing the problem and his partner. And also deep and professional study of the characteristics of the relationship in which the man is experiencing erectile dysfunction.

Another point worthy of note is that those types of psychotherapy which focus on performance anxiety (“brief therapies”) cannot directly address other psychological factors such as relationship dynamics. These would only be addressed during conventional psychodynamic psychotherapy or sexual psychotherapy, whether conducted individually or in a group.

In a study by Melnik the effectiveness of group psychotherapy was compared with the effectiveness of Viagra administered alone. The IIEF (international index of erectile function) was higher in the group that received group therapy: furthermore, there was a much higher rate of dropouts in the group given Viagra.

What does this mean? It seems clear that when the focus is on the administration of oral drug therapy, it’s all too easy for the psychological aspects of a man’s erectile problems, both in the origin and persistence of his dysfunction, to be neglected.

Viagra can be a very effective drug for some men suffering from erection problems. But for many men it’s clearly not effective when administered in isolation. Indeed, using Viagra in isolation can actually reveal other issues such as low libido, relationship difficulties, or premature ejaculation. The fact is, sexual dysfunction is a neurotic way of solving relationship conflicts or sexual problems for some couples. Clearly, in these cases, drug therapy alone is not an answer.

This particular study also looked at the persistence of erection problems in the men receiving group therapy and Viagra when compared to the men receiving Viagra only. The results were clear: a combined approach to therapy was more effective than either treatment approach alone. Hardly surprising, perhaps, but a very significant point that needs to be kept in mind by those who treat men with this erectile dysfunction.

Some research has shown that vacuum constriction devices (VCD) work just as effectively whether therapy is offered with them or not. However in other studies no significant differences have been discovered between psychotherapy with a VCD and psychotherapy without a VCD.

However,  the use of VCDs does appear to be somewhat limited these days. Viagra has significantly changed the way in which erection problems are addressed by both the physician and the man with erection problem. Viagra is indeed an effective medication and does restore erectile function for about 75% of the men who use it.

Of the other 25% a significant number can be helped to full erectile capacity with counseling and adjustment to the treatment regime. And it’s arguable that in every case, even those where Viagra works successfully, doctors should seek to offer appropriate counseling and therapy as well as medication.

The overall conclusion of this study is that group psychotherapy can improve a man’s erectile capacity. Indeed group therapy shows greater effectiveness than the absence of therapy (not surprisingly), but it also shows that when administered together with Viagra, effectiveness of the treatment regime is significantly increased.

There is also a need for effective follow-up to the studies so that the longer term outcome can be carefully assessed. The questions that need to be addressed are: does any particular type of psychological intervention seem to be more effective than any other? And how do personality factors, concurrent diagnosis of other conditions, either physical or emotional, affect therapy for ED? How do factors such as the motivation of the men concerned, their adherence to treatment strategies, dropout rates and the difficulties faced by examinations in this area affect the outcome of treatment?

http://www3.interscience.wiley.com/cgi-bin/fulltext/119879142/main.html,ftx_abs