Erection problems

Effectiveness of various treatment regimes by the Severity of 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 simply waiting list treatment for the outcome "persistence of ED".

Effectiveness by the Average (Mean) Age of Patients

In a subgroup study comparing men between 30 and 39 years old to men at 45 years old and older no statistical differences were identified.

Effectiveness According to Partnership

In a subgroup analysis of studies with men with fixed partnership compared to men without fixed partnership, only one subgroup showed statistically significant treatment benefits.

Psychological and educational Intervention vs. No Treatment

Goldman studied the impact of a psychological education as an  intervention in addition to treatment of erectile dysfunction in older couples. Twenty couples at a multidisciplinary center for erection problems were recruited for participation in the study. They had to be (i) between the ages of 55 and 75; (ii) in a heterosexual relationship of at least 6 months (iii) have no major psychiatric disorder or severe marital distress and have experienced secondary erectile dysfunction.

The subjects were assessed at the start of the study and and immediately following treatment. A qualitative interview was done regarding the treatment condition at follow-up. Treatment was an educational workshop of unknown length. The objectives of the workshop were around knowledge levels regarding the human sexual response cycle and informing men about normal changes with age, as well as increasing comfort levels around the discussion of sexuality; the workshop also aimed to increase men's satisfaction with their sexuality; and also to increase participants' understanding and acceptance of their sexual difficulties.

Although the men taking part in the workshop had no significant increases in sexual pleasure from pre to post treatment comparing to control condition.

Group Interventions:  Standard Medical Treatment vs Systematic Desensitization

Kockott conducted a study to assess the effectiveness in therapy of treatment by systematic desensitization of erection problems. Three groups consisting of eight patients were treated with systematic desensitization or given conventional medication and provided with general advice (defined as standard medical treatment), or they were denoted as part of a control group (which was the waiting list, no treatment group). 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 Meinik and Abdo directly compared group therapy and Viagra - also known as Sildenafil citrate - in the treatment of Erectile Dysfunction. This investigation discovered significant difference between group therapy and the Sildenafil group as far as measurements on the IIEF was concerned.

The recorded rate of IIEF was better in the group therapy. There was also notable and significant difference at the three months follow-up as there was indeed for the percentage of dropouts between the two groups. 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 [21] 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, and 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.

Obviously the study which I'm reporting on here, although a review of published papers and not original research, gives some indication of the value of different approaches to treatment for erection problems. One of the aspects of most value in this research is the fact that there are comparatively few studies that have demonstrated in a scientific way the effectiveness or otherwise of psychological interventions in the treatment of erectile issues. Indeed, this study appears to be the first one conducted to establish the effectiveness of psychological interventions. 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 on the basis of either 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, simply conclusions did emerge. First of all, group therapy does appear to be an effective methodology for treating erectile issues. Clearly group therapy is more effective than individual therapy, and since sexual therapy is an established method of treatment based on the assumption that sexual dysfunction has its origin in many different causes, and that 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 average 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 has been described as "psychoeducational" interventions did not produce statistically significant results between pre-and post treatment scores. This could be due to variations in the levels of knowledge between the control groups and the experimental groups, but the limitations of the study were such that there was little information about the content and format of the educational workshop, whether it was given by a professional medical or qualified therapist, and lack of detail around follow-up interviews.

Such lack of information in studies purporting to investigate the origin and treatment of erection problems is not unusual; certainly those studies which do not meet even basic scientific standards cannot provide us with any evidence as to the origin and best method of treating the problem. (Which is why this study has, despite its limited scope, provided some indication of the most effective treatment method.)

One of the conclusions is very interesting to most therapists who practice in this field 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, together with deep and professional study of the characteristics of the relationship in which the ED is manifesting. Furthermore, types of psychotherapy which focus on performance anxiety and are "brief therapies" will not directly address other psychological factors such as relationship dynamics which would 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 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.

Therefore, despite the fact that Viagra can be a very effective drug for a number of men suffering from erection problems, it's clearly not effective when administered in isolation in a significant number of cases. Indeed, using Viagra can actually reveal other issues such as low libido, relationship difficulties, or premature ejaculation. It's not an exaggeration to say that for a significant number of couples sexual dysfunction is a neurotic way of solving relationship conflicts or sexual problems, and clearly in these cases drug therapy is not an answer.

This particular study also went further in comparing the rate of persistence of erection problems in the men receiving group therapy and Viagra compared to the men receiving Viagra only. It is obvious that the men's own awareness of the emotional aspects of their condition was increased in the process of therapy: hardly surprising, but a very significant point that needs to be in the forefront of the minds of those who seek to treat men with this particular sexual dysfunction.

Intracavernosal injection (ICI) therapy has become rather less popular with the administration of Viagra, perhaps quite understandably, but interestingly enough the level of satisfaction with men receiving PGE1 injections was very similar to that of those receiving sexual psychotherapy.

It's also rather difficult to investigate the effectiveness of ICI injections because there is a significant rate of attrition in the treatment program due to the difficulties of injection or the man or his partner's reaction to the process of injection. Also, this is a treatment that does tend to require counseling and therapy from the physician when it is prescribed, which certainly obscures the effect of psychotherapy in any subsequent investigation.

It's been reported elsewhere that vacuum constriction devices work just as effectively where the 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. This is probably not such an important finding because 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 in question. And 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. There still remains a significant number of men for whom psychotherapy of one kind or another is necessary. It's arguable that in every case, even those were Viagra works successfully, that 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. The researchers make the observation that well conducted and clearly reported, randomized, controlled trials are necessary to establish how effective psychological treatment is in dealing with erection problems. 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?

The researchers make the recommendation that studies in this field should clearly state their methodology, involve double-blind methodologies, perform intention to treat analysis, and deal successfully with low study completion rates, with careful selection of patients who are highly motivated.

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

Continued here: summary of erection problems

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