The Effectiveness of Psychological Interventions for the Treatment of Erectile Dysfunction: Systematic Review and Meta-Analysis, Including Comparisons to Sildenafil Treatment, Intracavernosal Injection, and Vacuum Devices

Abstract

Introduction In contrast to the impressive advances in somatic research of erectile dysfunction (ED), scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED. Aim Authors conducted a meta-analysis to evaluate the effectiveness of psychological interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices, or other psychological intervention. Method Distinct sources of randomized controlled trials (RCTs) were searched: electronic databases (between 1966 and 2007), cross checking of references, and contact with scientific societies. Main Outcome Measures For dichotomous outcomes the pooled relative risks were calculated and for continuous outcomes mean differences between interventions. Statistical heterogeneity was addressed. Results Eleven RCTs involving 398 men met the inclusion criteria. Conclusions There is evidence that group therapy improves ED. Focused sex group therapy showed greater efficacy than control group. Men randomized to receive psychotherapy plus sildenafil showed significant improvement of ED and were less likely than those receiving only sildenafil to drop out. Regarding to the effectiveness of psychological interventions for the treatment of ED compared to local injection and vacuum devices no difference was found.

Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction

“…Nowadays, it is well recognized that this picture is too limitative and the introduction of effective and relatively safe phosphodiesterase type 5 inhibitors (PDE5) have drastically changed the landscape. However, a recently published meta‐analysis—assessing the effectiveness of psychological interventions for the treatment of erectile dysfunction (ED) as compared with medical treatment—supports the value of focused sex group psychotherapy alone or in combination with PDE5 [7].…”

Nonresponse to PDE5 inhibitors in erectile dysfunction. Part 2

“…In terms of PDE5-Is use, it has been reported that the therapeutic outcome of sildenafil plus brief couple sex therapy or cognitive-behavior sex therapy showed higher rates of clinical success than sildenafil alone for treatment of men with ED of mixed etiology or men with psychogenic ED [30,31]. These findings were confirmed by the results of a meta-analysis study that showed that men randomized to receive psychotherapy plus sildenafil were less likely to drop out than those receiving only sildenafil [32].…”

PDE-5 inhibitors in monotherapy versus combination therapy in a sample of 1200 patients with erectile dysfunction

“…A meta-analysis with 398 men showed better effectiveness and greater adherence to treatment when psychosexual therapy is combined with PDE5i in comparison to simple administration of PDE5i (46,47).…”