Dating skills training in the group treatment of erectile dysfunction for men without partners

Psychosocial interventions for erectile dysfunction

BACKGROUND

Normal sexual function is a biopsychosocial process and relies on the coordination of psychological, endocrine, vascular, and neurological factors. Recent data show that psychological factors are involved in a substantial number of cases of erectile dysfunction (ED) alone or in combination with organic causes. However, in contrast to the advances in somatic research of erectile dysfunction, scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED.

OBJECTIVES

To evaluate the effectiveness of psychosocial interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices and other psychosocial interventions, that may include any psycho-educative methods and psychotherapy, or both, of any kind.

SEARCH STRATEGY

The following databases were searched to identify randomised or quasi-randomised controlled trials: MEDLINE (1966 to 2007), EMBASE (1980 to 2007), psycINFO (1974 to 2007), LILACS (1980 to 2007), DISSERTATION ABSTRACTS (2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2007). Besides this electronic search cross checking the references of all identified trials, contact with the first author of all included trials was performed in order to obtain data on other published or unpublished trials. Handsearch of the International Journal of Impotence Research and Journal of Sex and Marital Therapy since its first issue and contact with scientific societies for ED completed the search strategy.

SELECTION CRITERIA

All relevant randomised and quasi-randomised controlled trials evaluating psychosocial interventions for ED.

DATA COLLECTION AND ANALYSIS

Authors of the review independently selected trials found with the search strategy, extracted data, assessed trial quality, and analysed results. For categorical outcomes the pooled relative risks (RR) were calculated, and for continuous outcomes mean differences between interventions were calculated as well. Statistical heterogeneity was addressed.

MAIN RESULTS

Nine randomised (Banner 2000; Baum 2000; Goldman 1990; Kilmann 1987; Kockott 1975; Melnik 2005; Munjack 1984; Price 1981; Wylie 2003) and two quasi-randomised trials (Ansari 1976; Van Der Windt 2002), involving 398 men with ED (141 in psychotherapy group, 109 received medication, 68 psychotherapy plus medication, 20 vacuum devices and 59 control group) met the inclusion criteria. In data pooled from five randomised trials (Kockott 1975; Ansari 1976; Price 1981; Munjack 1984; Kilmann 1987), group psychotherapy was more likely than the control group (waiting list - a group of participants who did not receive any active intervention) to reduce the number of men with "persistence of erectile dysfunction" at post-treatment (RR 0.40, 95% CI 0.17 to 0.98, N = 100; NNT 1.61, 95% CI 0.97 to 4.76). At six months follow up there was continued maintenance of reduction of men with "persistence of ED" in favour of group psychotherapy (RR 0.43, 95% CI 0.26 to 0.72, N = 37; NNT 1.58, 95% CI 1.17 to 2.43). In data pooled from two randomised trials (Price 1981; Kilmann 1987), sex-group psychotherapy reduced the number of men with "persistence of erectile dysfunction" in post-treatment (RR 0.13, 95% CI 0.04 to 0.43, N = 37), with a 95% response rate for sex therapy and 0% for the control group (waiting list - no treatment) (NNT 1.07, 95% CI 0.86 to 1.44). Treatment response appeared to vary between patient subgroups, although there was no significant difference in improvement in erectile function according to mean group age, type of relationship, and severity of ED. In two trials (Melnik 2005; Banner 2000) that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant reduction of "persistence of ED" (RR 0.46, 95% CI 0.24 to 0.88; NNT 3.57, 95% CI 2 to 16.7, N = 71), and were less likely than those receiving only sildenafil to drop out (RR 0.29, 95% CI 0.09 to 0.93). One small trial (Melnik 2005) directly compared group therapy and sildenafil citrate. It found a significant difference favouring group therapy versus sildenafil in the mean difference of the IIEF (WMD -12.40, 95% CI -20.81 to -3.99, N = 20). No differences in effectiveness were found between psychosocial interventions versus local injection and vacuum devices.

AUTHORS' CONCLUSIONS

There was evidence that group psychotherapy may improve erectile function. Treatment response varied between patient subgroups, but focused sex-group therapy showed greater efficacy than control group (no treatment). In a meta-analysis that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant improvement of successful intercourse, and were less likely than those receiving only sildenafil to drop out. Group psychotherapy also significantly improved ED compared to sildenafil citrate alone. Regarding the effectiveness of psychosocial interventions for the treatment of ED compared to local injection, vacuum devices and other psychosocial techniques, no differences were found.

Sexual dysfunction in single males: a perspective from India

Various personal, familial, and socio-cultural factors play a crucial role in the development of sexuality and sexual practices. They often influence the occurrence and maintenance of sexual dysfunctions. Therapies with individuals with sexual dysfunctions often emphasize the involvement of both the partners. Issues related to single males, especially in the Indian context, have not been explored. The present study is a retrospective analysis of clinical case records of single males who reported sexual dysfunctions between the years 1990 to 2000. Thirty-eight clinical case records were analyzed for the demographic details, nature of the problems, and interventions provided with the aim of exploring the reported symptomatology, precipitating and maintaining factors, prevalent beliefs about the causation of sexual dysfunction, and the outcome of interventions. The role of cultural and psychosocial issues is discussed and the need for research in this area is emphasized.

The treatment of sexually dysfunctional men without partners: a controlled study of three behavioural group approaches

BACKGROUND

Models of sex therapy for sexual dysfunction in single men are available, but their value is not well established. This controlled study compared three approaches to the treatment of sexually dysfunctional single men.

METHOD

Sixty-nine single men diagnosed as sexually dysfunctional were randomly assigned to treatments focusing on either their sexual dysfunction, their interpersonal problems, a combination of both or a waiting list; 51 completed treatment and 50 the one-year follow-up. Treatment was administered in small groups in 15 weekly sessions and four six-weekly sessions during the first six months of a year-long follow-up.

RESULTS

No clinically meaningful change was observed during the waiting period. In contrast, a significant and equivalent improvement was observed in all treatment groups by the end of treatment. However, differences between them were in evidence at 6 and 12 months' follow-up.

CONCLUSIONS

Both treatments paying attention to the patients' interpersonal difficulties resulted in significantly better outcomes overall than the approach that concentrated on problems in sexual functioning alone.

Treatment of sexual dysfunctions by sex therapy and other approaches

BACKGROUND

The treatment of sexual dysfunctions underwent a great change when sex therapy was developed more than 25 years ago. Since then the treatment programme has been modified in various ways, the response to treatment evaluated and other treatment approaches introduced.

METHOD

A review of the literature concerning the application and outcome of sex therapy and other treatments for sexual dysfunction was conducted.

RESULTS

The format of effective conjoint sex therapy is now fairly clear and there is good understanding of the sexual dysfunctions that respond best to this treatment and the couples most likely to benefit. Less is known about the effects of treatment of individuals without partners, bibliotherapy and combining sex therapy with marital therapy and with physical methods of treatment.

CONCLUSIONS

Sex therapy is now a well-established form of treatment. It should be more widely available for patients seen in psychiatry departments.

Group treatment of sexual dysfunctions: a methodological review of the outcome literature

This paper reviewed 36 studies which examined the effects of the group format in the treatment of sexual dysfunctions. The methodological evaluation was conducted within the following sections: subjects, therapists, treatment goals, group composition, time format, treatment, outcome measures and assessment times. Numerous methodological deficiencies were found, most notably the inadequate definitions of dysfunction and treatment success, the failure to control for therapist or expectancy factors, the failure to isolate the specific effects of different treatments, and an absence of control or comparison groups. The data tentatively suggest that a group format is effective in the treatment of female orgasmic dysfunction and secondary erectile dysfunction. Same-sex only groups and couples' groups promote comparable improvements. It is premature to make any conclusive statements regarding the relative efficacy of group and individual treatment formats. Future investigators should examine the specific and relative effects of the various treatment components and explore the potential therapeutic advantages of the group in the treatment of sexual dysfunction.