Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study

Abstract

Introduction An increasing number of young men have been found to develop nonorganic erectile dysfunction (NOED) in recent years. The NOED has been shown to respond better to cognitive behavior sex therapy (CBST) in a few past studies. Aim The present research aims to establish the efficacy of CBST as a promising treatment option in young men suffering from NOED by administering a feasibility pilot trial. Methods 28 young men (M = 31 years) out of a total of 39 men (7 excluded, 4 quit treatment) diagnosed with NOED from sexual health clinics in Pakistan were recruited to receive CBST treatment (n = 13) on average twice a week for a period of 50 minutes per session for a period of 4, 6, 8, and 12 weeks for the mild, mild to moderate, moderate, and severe forms of NOED, respectively, and sildenafil citrate group (n = 15) receiving sildenafil citrate 50 mg on demand. The trial design was sequential random assignment clinical trial. Main Outcome Measures International Index of Erectile Functoning-5 and Depression Anxiety Stress Scale-21 were used before treatment, after treatment, and in follow-up as the main outcome measures. Results The repeated measures analysis of covariance established a nonsignificant difference between CBST and sildenafil citrate 50 mg in NOED scores improvement, NOED severity reduction, and reduction in depression scores at posttreatment assessment. There were significant differences among different CBST modalities in improving NOED scores, reduction in NOED severity, and depression scores. There was significant difference in CBST and sildenafil citrate 50 mg in anxiety reduction at posttreatment assessment. The covariates age, age groups, and NOED duration did not significantly impact the treatment outcome for both treatment groups except age which impacted the interaction of treatment and anxiety scores. Conclusion The CBST is an emerging and promising treatment choice in younger men suffering from NOED. Bilal A, Abbasi NuH. Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study. J Sex Med 2020;8:396–407.

The effectiveness of psychological interventions alone, or in combination with phosphodiesterase-5 inhibitors, for the treatment of erectile dysfunction:A systematic review

“…(1) In cases of psychogenic ED, combined approaches allow the management of psychosocial factors that cannot be tackled by PDE-5i alone. Despite their limitations, three studies in the present review [24][25][26] found that combining individual CBST with PDE-5i was not only superior to PDE-5i when measuring ED improvement, but also in reducing anxiety levels. (2) Combined therapy can also increase treatment satisfaction and results in better long-term improvement.…”

“…Concerning PI, three studies used individual CBT/ CBST [24][25][26], three studies employed group therapybased interventions [27][28][29], three studies used couple-CBST [30][31][32], and four studies employed internetbased CBT [33][34][35][36]. PI duration ranged from an average of 4-12 weeks.…”

“…Regarding PDE-5i, six studies used sildenafil [25,26,[28][29][30][31], one used vardenafil [32], and six did not specify the drug used by the patients [24,25,[33][34][35][36].…”

“…Moreover, because these patients fail to understand the rationale behind PI, many do not adhere to the treatment [42,43]. However, the present review included two studies and one follow-up study from non-Western cultures [24][25][26]. These studies had promising results suggesting that PI and combined interventions could be successfully used in the management of psychogenic ED in a non-Western cultural context.…”

Comprehensive Intersystemic Assessment Approach to Relieve Psychogenic Erectile Dysfunction: A Review

“…They concluded that this therapy was emerging and promising treatment choice in younger men suffering from psychogenic ED. Although this study is far from being a perfect design, it is a good pilot study to show that CBT is a good solution [36]. Still from Pakistan, Khan et al conducted the same study on 60 men who had ED.…”