What is the role sexual counseling and psychotherapy in the treatment of erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Sexual counseling is the most important part of treatment for patients with sexual problems. Many professional sexual counselors are skilled in working with patients, but the primary care physician, the urologist, and the gynecologist also serve in this capacity to some degree. These are usually the first professionals to learn about the problem, and they often have to extract the information about the sexual problem from the patient.

Men are frequently reluctant to discuss their sexual problems and must be specifically asked. Opening a dialogue allows the clinician to begin the investigation or to refer the patient to a consultant. Regardless of any subsequent therapy, the emotional aspects of the disorder must be addressed. Ideally, the patient’s partner should be involved in counseling, but even if this is not possible, the time spent may help resolve or at least clarify the problem and certainly helps determine which of the other options would be most beneficial and appropriate.

Regardless of the etiology of ED, a psychological component is frequently associated with the disorder. The ability to achieve erection is intimately connected to a man’s self-esteem and sense of worth. Pure psychogenic ED is generally evident when a man reports that he has normal erections some of the time but is unable to achieve or to maintain a full erection at other times. Once the man has doubt regarding sexual performance, he loses confidence; thus, future attempts to have sexual relations provoke anxiety.

In many instances, the couple must work together to resolve the problem, although in some cases, the relationship itself may be responsible for the problem. Referral to a sex therapist may be helpful.

A study of 31 newly diagnosed men with ED (aged 20-55 years) who were treated with either tadalafil (n = 12) or tadalafil plus 8 weeks of stress management (n = 19) found that both groups showed significant improvement in perceived stress and erectile function scores but that the reduction in perceived stress was greater in the latter group. [112] This result suggests that stress reduction may be a useful component of ED treatment. Further research, involving randomized, controlled trials with larger samples and longer follow-up time, is needed.

Men with organic ED can be treated with one or more of the various available therapies (see above). However, if they have lost confidence in their ability to obtain and maintain an erection suitable for penetration, a few words of encouragement from their physician can be of great help.

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