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Revitalizing Psychiatry
Erectile Dysfunction (ED) Affects Approximately from 18 to 30 Million American
Men
Erectile dysfunction (ED) is a common sexual complaint in men, which has become the focus of intense
public and professional attention [1] since the approval of Viagra and recently Levitra. In the
Massachusetts Male Aging Study (MMAS) [2], a community-based survey of men between the ages of 40
and 70 years, 52% of respondents reported some degree of erectile difficulty. Complete ED, defined as
the total inability to obtain or maintain erections during sexual stimulation, as well as the absence of
nocturnal erections, occurred in 10% of respondents. Lesser degrees of mild and moderate ED occurred
in 17% and 25%, respectively. In the National Health and Social Life Survey (NHSLS) [3], a nationally
representative probability sample of men and women ages 18 and 59, 10.4% of men reported being unable
to achieve or maintain an erection during the past year. Both studies observed a strong relationship to
age. If the MMAS data are extrapolated, there are an estimated 18 to 30 million American men who are
affected by ED.
Importance of Combined Medical and Sex Therapy Approaches in Treatment of
ED
ED has been associated with a wide range of medical and psychological difficulties, including depression,
marital discord, and even employment changes. Physical causes include hypertension, diabetes, and
side effects associated with prescription or nonprescription drug use. Guidelines for integrating medical
and sexual/psychological interventions. At the simplest level, patients need to be educated about the
mechanism of action of the drug and the need for concomitant sexual stimulation along with a drug use.
Beyond this, many couples also need to address sexual initiation issues, conflicts or resentments in the
relationship, loss of sexual desire, and sexual performance difficulties in the partner. A treatment
outcome is much less likely to be successful if these areas are not adequately addressed.
Problems of Initiation
In couples with long-standing ED, initiating or resuming sexual activity may be difficult following an
extended period of sexual abstinence [1]. ED typically leads to sexual apathy or avoidance in one or both
partners, and that specific interventions may be required to assist the couple in resuming sexual activity.
Sexual avoidance in these cases may be related to embarrassment or fear of failure on the part of the
male, unrealistic beliefs or expectations, relationship conflicts, and low sexual desire in one or both
partners. Many couples make long-term adjustments in their relationships or lifestyles to the absence of
sexual activity, and the availability of the drugs may not be a sufficient stimulus to overcome the sexual
inertia that permeates their relationship. Few physicians assess the sexual relationship beyond the male’
s ability to achieve satisfactory erection or orgasm, and problems of initiation are unlikely to be
addressed in this setting. About one fourth of the couples are unable to sustain initial improvements with
the drugs, which leads to drug discontinuation and additional stress. Many of these couples appeared to
have difficulty in resuming or maintaining an active sexual relationship. A psychiatric/psychological
assessment, treatment and combination of right drugs can significantly improve chances of success.
Problems of Low Desire
Men with ED frequently have concomitant low desire or premature ejaculation (PE), either as a cause or
as a consequence of their ED. An estimated one third of ED cases have low desire to a significant degree
[1]. A careful assessment of the previous sexual history of the couple with special attention to each
partner’s past sexual feelings, desires and experiences should be conducted by qualified
psychiatrist/psychologist in order to help such couples. For men, sexual intercourse may have long-
standing associations with performance anxiety [4] or an overall sense of inadequacy. Such individuals
may feel threatened or insecure at the prospect of having to “perform” again sexually. Similarly, female
partners frequently have sexual insecurities or dysfunctions of their own, and the loss of erectile ability in
the male may be associated with feelings of relief in the female partner. These issues should be
identified and openly addressed by a psychiatrist/psychologist.
References
1. Rosen, R.C. Medical and Psychological Interventions for Erectile Dysfunction. Toward a Combined
Treatment Approach. In Principles and Practice of Sex Therapy. Third Edition, New York, The Guilford
Press, 2000.
2. Feldman, H. A., et al. (1994). Impotence and its medical and psychosocial correlates: results of the
Massachusetts Male Aging Study. Journal of Urology, 151, 54-61.
3. Laumann, E. O., et al. The social organization of sexuality: Sexuality practices in the United States.
Chicago: University of Chicago Press.
4. Apfelbaum, B. On Performance-Anxiety Anxiety
Men
Erectile dysfunction (ED) is a common sexual complaint in men, which has become the focus of intense
public and professional attention [1] since the approval of Viagra and recently Levitra. In the
Massachusetts Male Aging Study (MMAS) [2], a community-based survey of men between the ages of 40
and 70 years, 52% of respondents reported some degree of erectile difficulty. Complete ED, defined as
the total inability to obtain or maintain erections during sexual stimulation, as well as the absence of
nocturnal erections, occurred in 10% of respondents. Lesser degrees of mild and moderate ED occurred
in 17% and 25%, respectively. In the National Health and Social Life Survey (NHSLS) [3], a nationally
representative probability sample of men and women ages 18 and 59, 10.4% of men reported being unable
to achieve or maintain an erection during the past year. Both studies observed a strong relationship to
age. If the MMAS data are extrapolated, there are an estimated 18 to 30 million American men who are
affected by ED.
Importance of Combined Medical and Sex Therapy Approaches in Treatment of
ED
ED has been associated with a wide range of medical and psychological difficulties, including depression,
marital discord, and even employment changes. Physical causes include hypertension, diabetes, and
side effects associated with prescription or nonprescription drug use. Guidelines for integrating medical
and sexual/psychological interventions. At the simplest level, patients need to be educated about the
mechanism of action of the drug and the need for concomitant sexual stimulation along with a drug use.
Beyond this, many couples also need to address sexual initiation issues, conflicts or resentments in the
relationship, loss of sexual desire, and sexual performance difficulties in the partner. A treatment
outcome is much less likely to be successful if these areas are not adequately addressed.
Problems of Initiation
In couples with long-standing ED, initiating or resuming sexual activity may be difficult following an
extended period of sexual abstinence [1]. ED typically leads to sexual apathy or avoidance in one or both
partners, and that specific interventions may be required to assist the couple in resuming sexual activity.
Sexual avoidance in these cases may be related to embarrassment or fear of failure on the part of the
male, unrealistic beliefs or expectations, relationship conflicts, and low sexual desire in one or both
partners. Many couples make long-term adjustments in their relationships or lifestyles to the absence of
sexual activity, and the availability of the drugs may not be a sufficient stimulus to overcome the sexual
inertia that permeates their relationship. Few physicians assess the sexual relationship beyond the male’
s ability to achieve satisfactory erection or orgasm, and problems of initiation are unlikely to be
addressed in this setting. About one fourth of the couples are unable to sustain initial improvements with
the drugs, which leads to drug discontinuation and additional stress. Many of these couples appeared to
have difficulty in resuming or maintaining an active sexual relationship. A psychiatric/psychological
assessment, treatment and combination of right drugs can significantly improve chances of success.
Problems of Low Desire
Men with ED frequently have concomitant low desire or premature ejaculation (PE), either as a cause or
as a consequence of their ED. An estimated one third of ED cases have low desire to a significant degree
[1]. A careful assessment of the previous sexual history of the couple with special attention to each
partner’s past sexual feelings, desires and experiences should be conducted by qualified
psychiatrist/psychologist in order to help such couples. For men, sexual intercourse may have long-
standing associations with performance anxiety [4] or an overall sense of inadequacy. Such individuals
may feel threatened or insecure at the prospect of having to “perform” again sexually. Similarly, female
partners frequently have sexual insecurities or dysfunctions of their own, and the loss of erectile ability in
the male may be associated with feelings of relief in the female partner. These issues should be
identified and openly addressed by a psychiatrist/psychologist.
References
1. Rosen, R.C. Medical and Psychological Interventions for Erectile Dysfunction. Toward a Combined
Treatment Approach. In Principles and Practice of Sex Therapy. Third Edition, New York, The Guilford
Press, 2000.
2. Feldman, H. A., et al. (1994). Impotence and its medical and psychosocial correlates: results of the
Massachusetts Male Aging Study. Journal of Urology, 151, 54-61.
3. Laumann, E. O., et al. The social organization of sexuality: Sexuality practices in the United States.
Chicago: University of Chicago Press.
4. Apfelbaum, B. On Performance-Anxiety Anxiety
Erectile Dysfunction