Does the Addition of Psychosexual Counselling to Medical Treatment of ED really Improve Long Term Treatment Outcomes?

The realization and agreement in that erectile dysfunction (ED) usually involves both biogenic and psychogenic factors in its causation has prompted the discussion on the need/advantage/feasibility of combining treatments modalities for some men with ED. The rational for combining both medical and psychosexual treatments is clearly seen in clinical practice: many failures to ED treatment with PDE5 inhibitors can be explained by psychosexual factors such as deficient sexual technique, extreme anxiety and conflict with the partner that prevents the development of the appropriate conditions for the treatment to work. Another reason for adding psychosexual counselling is seen with relative frequency in the young patient with no clear risk factors identified but there are psychological determinants of the dysfunction which can be removed with psychotherapy. However, the evidence for this possible advantage in the addition of Psychosexual Counselling for ED has not yet been produced. There is already some evidence of the advantages that the addition of psychosexual counselling/therapy or/ the addition of drugs to the traditional psychotherapeutic treatment, for the case of premature ejaculation, hypoactive sexual desire in females, and vaginismus. The lack of available evidence does not translate automatically into the conclusion that the combination approach is worthless. The need for further evaluating the combined psychosexual and medical treatment of ED will be assessed in the presentation. The identification of patient’s characteristics that will predict benefit form the combination of treatments is perhaps one of the most urgent pending tasks among clinical sexologists


Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007