title: The PsychoedPlusMed Approach to Erectile Dysfunction Treatment: The Impact of Combining a Psychoeducational Intervention with Sildenafil Sexual satisfaction among patients with erectile dysfunction treated with counseling, sildenafil, or both. Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms Comparing Sildenafil Alone Vs. Sildenafil Plus Brief Couple Sex Therapy on Erectile Dysfunction and Couples' Sexual and Marital Quality of Life: A Pilot Study EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction. [Therapeutic choices of penile erectile dysfunction]. The multinational Men's Attitudes to Life Events and Sexuality (MALES) Study Phase II: understanding PDE5 inhibitor treatment seeking patterns, among men with erectile dysfunction. Integrated sildenafil and cognitive-behavior sex therapy for psychogenic erectile dysfunction: a pilot study. The male sexual quotient: a brief, self-administered questionnaire to assess male sexual satisfaction.
abstract: We investigated the effect of adding a psychoeducational intervention to oral sildenafil ( PsychoedPlusMed ) in the treatment of  erectile dysfunction ( ED ) . Overall treatment satisfaction , as measured by the Erectile Dysfunction Inventory of Treatment Satisfaction ( EDITS ; Althof & Seftel , 1995 ) , was significantly higher in the PsychoedPlusMed  patients than in the sildenafil-only patients at 12 weeks and at 24 weeks . PsychoedPlusMed participants reported higher satisfaction with treatment onset , treatment duration , and sexual confidence .  PsychoePlusMed participants also reported an increase in communication about sex with their partner . A brief psychoeducational intervention can improve treatment satisfaction with sildenafil therapy for ED INTRODUCTION Sexual satisfaction is linked to life satisfaction , and erectile dysfunction ( ED ) may lead to an impaired quality of life ( QOL ) . AIM Our goal was to evaluate the QOL among Brazilian patients with ED , before and after three kinds of treatment . METHODS Men aged 25 - 55 years , with a diagnosis of psychogenic or mixed ED , according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases , 10th edition , and the St and ard Practice in Sexual Medicine , were r and omly assigned to three treatment groups : counseling , sildenafil , and sildenafil plus counseling . At baseline each group had 40 patients .  Sildenafil was provided in 50 mg that could be adjusted to 100 mg . The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months . Counseling was provided in group sessions that took place once a week . They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient ( MSQ ) and the Sexual Health Inventory for Men ( SHIM ) . MAIN OUTCOME MEASURES The correlation between the patients ' MSQ score and scores on the SHIM . RESULTS One hundred seventeen patients were enrolled . The three groups were similar according to age , marital status , mean time of ED , and ED severity and etiology . At baseline , MSQ and SHIM total scores were not different among the three groups . MSQ scores increased from 41.2 + /- 15.3 , 38.7 + /- 18.0 , and 46.8 + /- 17.0 to 48.5 + /- 15.3 , 63.8 + /- 21.6 , and 70.0 + /- 17.3 after counseling , sildenafil , and sildenafil plus counseling , respectively ( P < 0.05 ) . SHIM scores also increased significantly ( 9.6 + /- 4.1 , 9.7 + /- 4.1 , and 10.2 + /- 3.9 to 12.1 + /- 3.9 , 16.7 + /- 5.6 , and 17.7 + /- 4.5 after counseling , sildenafil , and sildenafil plus counseling , respectively ) ( P < 0.05 ) . There were no serious adverse events related to sildenafil , and no patient was withdrawn from the study because of an adverse event . CONCLUSIONS The three treatments were significantly efficient , and the best treatment was sildenafil associated with counseling We admistered the International Index of Erectile Function ( IIEF ; Rosen et al. , 1997 ) question naire to 30 patients with psychogenic erectile dysfunction ( ED ) at baseline , immediately after treatment , and 3 months after treatment . We r and omized patients into three groups : group I , who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on dem and ; group II , who had an intake of 50 mg sildenafl citrate orally on dem and for 6 months only ; and group III , who had weekly sessions of time-limited theme-based group psychotherapy for 6 months . We analyzed data ( 15-item IIEF ) for each group at three times during the study and compared by the data using analysis of variance ( ANOVA ) , followed by the Bonferroni multiple comparison test . We used Cochran 's Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms ( EF equal to or higher than 26 points ) . Group III had a mean score higher than group II , with the difference being statistically significant ( immediately after treatment , p = 0.033 ; at 3 months after treatment , p = 0.049 ; p < 0.05 ) . All three therapeutic alternatives result ed in an improvement of erectile function domain score . However , significant differences from baseline were observed in groups I ( p = 0.0009 ) and III ( p = 0.0002 ) but not in group II ( p = 0.135 ) . The psychotherapy groups , I and III , had significantly higher scores compared with group II , in which patients were exclusively treated with sildenafil citrate . These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED Erectile dysfunction ( ED ) is commonly associated with depressed mood and diminished quality of life ( QoL ) , but few studies have investigated the causal associations involved . Therefore , we evaluated the correlation between several measures of mood , QoL , and sexual function in a retrospective analysis of a sample of depressed men ( n=152 ) , with ED enrolled in a clinical trial of sildenafil citrate ( VIAGRA ® ) .  Strong correlations were observed at baseline among measures of erectile function ( EF ) , mood , and overall QoL. Significant treatment effects were observed on all three domains , with significant interactions between changes in mood and QoL. Based on multiple regression and path analysis , a model was developed in which EF changes were associated with improved mood and quality of sexual life , which result ed in improved partner satisfaction , family life , and overall life satisfaction . These data suggest that QoL changes associated with ED therapy may be mediated by changes in sexual function , mood , and family relationships Treatment options for managing erectile dysfunction ( ED ) include medical and psychological interventions . The present study examined the effectiveness of a drug-only vs. combined treatment approach on erectile function as well as other domains of sexual function and cognition , couple intimacy and adaptation , and treatment satisfaction .  Couples with ED were r and omly assigned to either Viagra-only ( VO ) or Viagra plus sex therapy ( VST ) .  Sexual and relationship variables were measured at specific time points . Despite limitations , study findings extend previous conclusions and provide empirical support for the effectiveness and satisfaction with the combined treatment approach for treating men with ED of mixed etiology OBJECTIVES To develop Patient and Partner versions of a psychometrically sound question naire , the EDITS ( Erectile Dysfunction Inventory of Treatment Satisfaction ) , to assess satisfaction with medical treatments for erectile dysfunction . METHODS Treatment satisfaction differs from treatment efficacy as it focuses on a person 's subjective evaluation of treatment received . Twenty-nine items representing the domain of treatment satisfaction for men and 20 representing partner satisfaction were generated . Two independent sample s of 28 and 29 couples completed all items at two points in time . Spearman rank-order correlations were derived to assess test-retest reliability and couple coefficients of validity . Internal consistency coefficients were calculated for both Patient and Partner versions and a content validity panel was used to analyze content validity . RESULTS Only items that met all the following criteria were selected to comprise the final question naires : ( a ) range of response four or more out of five ; ( b ) test-retest reliability greater than 0.70 ; ( c ) ratings by at least 70 % of the content validity panel as belonging in and being important for the domain ; and ( d ) significant correlation between the subjects ' and partners ' responses . Eleven patient items met criteria and formed the Patient EDITS ; five partner items met criteria and formed the Partner EDITS . Scores on the two inventories were normally distributed with internal consistencies of 0.90 and 0.76 , respectively . Test-retest reliability for the Patient EDITS was 0.98 ; for the Partner EDITS , it was 0.83 . CONCLUSIONS Reliability and validity were well established , enabling the EDITSs to be used to assess satisfaction with treatment modalities for erectile dysfunction and to explore the impact of patient and partner satisfaction on treatment continuation OBJECTIVES To discuss the therapeutic choices of erectile dysfunction ( ED ) and to improve the therapeutic efficacy for different ED cases . METHODS Two hundred and twenty-seven patients with ED were treated repectively with psychological treatment(31 cases ) , oral testosterone(30 cases ) , Viagra(121 cases ) , psychological treatment + Viagra ( 16 cases ) , intraurethral PGE1 ( 8 cases ) and intracavemous injection(21 cases ) . RESULTS Among those ED patients , 142 ( 62.6 % ) cases reported improved erections after they had undergone above-mentioned therapies . The improved patients include 12 cases(38.7 % ) with psychological treatment , 9 cases ( 30.0 % ) with oral testosterone , 91 cases ( 75.2 % ) with Viagra , 13 cases ( 81.3 % ) with psychological and Viagar , 2 cases ( 25.0 % ) with intraurethral PGE1 and 21 cases ( 71.4 % ) with intracavemous injection . CONCLUSIONS ED is a highly individualized disease , therapeutic choices of ED based on patient 's situation can benefit those patients OBJECTIVE The aim of Phase II of the Men 's Attitudes to Life Events and Sexuality ( MALES ) Study is to explore PDE5 inhibitor treatment seeking among men with erectile dysfunction ( ED ) . METHODS Phase II of the MALES study involved 2,912 men , aged 20 - 75 years , from 8 countries ( U.S. , U.K. , Germany , France , Italy , Spain , Mexico , and Brazil ) , who reported ED . Participants were recruited from the MALES Phase I sample [ 1 ] and via booster methods ( e.g. , physician referral , street interception ) , and completed self-report question naires concerning the characteristics of their ED , their efforts to seek PDE5 inhibitor treatment for their sexual dysfunction , and attitudinal and referent influences that potentially affect treatment-seeking . Statistical analyses focus on identification of correlates of PDE5 inhibitor treatment seeking . RESULTS PDE5 inhibitor utilization is strongly associated with ED sufferers ' assessment of the severity of their sexual dysfunction , with their belief that medication for ED is dangerous , and with their perceptions of whether physicians , other professionals , and spouses or family members are supportive of their seeking treatment . ED sufferers who evaluate their sexual dysfunction as severe , who believe that medication for ED is not dangerous , and who perceive support for treatment seeking from referent others , are more likely to utilize PDE5 inhibitor treatment . CONCLUSION Findings indicate that perceived ED severity , beliefs about ED medication , and referent influences are strongly correlated with utilization of PDE5 inhibitor therapy . These findings aid our underst and ing of factors that may incline men with ED to seek-or to avoid-PDE5 inhibitor therapy for their sexual dysfunction , and provide a basis for clinical and educational interventions to assist men with ED to seek appropriate treatment INTRODUCTION Men with psychogenic erectile dysfunction ( ED ) present a challenge to physicians . Treatment with pharmacological agents alone does not address the complexities of the causative or result ing psychological issues . AIM To evaluate the effectiveness of an integrative treatment protocol ( ITP ) with sildenafil and cognitive-behavior sex therapy ( CBST ) compared with sildenafil alone for men with psychogenic ED . MAIN OUTCOME MEASURES Change from baseline on the International Index of Erectile Function ( IIEF ) in the domains of erectile function and sexual satisfaction to demonstrate improved sexual functioning and confidence . METHODS Men with psychogenic ED and female partners were r and omized to receive either sildenafil alone or an ITP with sildenafil and CBST for the first 4 weeks . In the last 4 weeks , couples in the sildenafil group added CBST sessions to their regimen ; patients in the ITP group continued the combined therapy . The IIEF question naire was used to compare erectile function and overall satisfaction serially at pretreatment , 4 , and 8 weeks . Couples who met the success criteria in both domains after the first 4 weeks received no further treatment . RESULTS Fifty-three couples constituted the study population . After the first 4 weeks of sildenafil and ITP , 48 % of men met criteria for success on erectile function and 65.5 % for satisfaction compared to men on sildenafil alone with 29 % and 37.5 % success rates , respectively . After the last 4 weeks , integration of CBST with sildenafil result ed in a 58 % success rate for erectile function which was comparable to the 66 % rate for the initial drug/ITP group ; satisfaction rates for men were 45 % and 75 % , respectively . CONCLUSIONS CBST was shown to have a positive influence when used throughout the entire 8 weeks of the ITP or added to the sildenafil in the last 4 weeks . Although patients in both treatment regimens had significant improvements in the IIEF domain scores confirming efficacy of sildenafil , those in the CBST and drug regimen achieved higher rates of clinical success within the first 4 weeks of therapy INTRODUCTION Sexual satisfaction is an important aspect of overall life satisfaction . The Male Sexual Quotient ( MSQ ) was design ed to provide a versatile , user-friendly instrument to measure various aspects of male sexual function and satisfaction . AIM Assess responses to the MSQ in men with sexual dysfunction ( SD ) . METHODS Items for inclusion in the MSQ were developed through interviewing 612 r and omly recruited men in São Paulo , Brazil , about factors considered to influence sexual quality of life . Validation of the MSQ was conducted in two phases in men with and without SD . MAIN OUTCOME MEASURE The correlation between patients ' total MSQ score and scores on the Sexual Health Inventory for Men ( SHIM ) . RESULTS The result ing MSQ question naire contains 10 items that address sexual function and satisfaction and is scored on a 100-point scale , with higher scores indicating greater sexual function and satisfaction with such function . Patients ' scores on the MSQ  were positively correlated with scores on the SHIM ( r = 0.86 ; P < 0.0001 ) . Scores on  MSQ item 8 , which assesses ejaculatory control , indicated that 46 % of patients may have premature ejaculation ( PE ) . The mean time for patients to complete the MSQ was 11 minutes . CONCLUSIONS The MSQ is a brief , comprehensive , and easily self-administered tool design ed to help men identify aspects of their sexual experience that could be improved through partner dialogue , physician consultation , and appropriate treatment .  MSQ scores correlated well with SHIM scores , and scores were inversely related to the severity of erectile dysfunction or PE and other male SDs . These preliminary findings suggest that the MSQ possesses good convergent validity . Nearly half of men reported problems with ejaculatory control , indicating an association between PE and other SD . Further validation of the MSQ in a double-blind trial is needed . The MSQ may aid in decision making for the treatment of SD
target: The results of the included studies are inconclusive , though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone .
  The meta- analysis found that , overall , combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone .
  Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction .
  No differences were found between PDE5-Is and PI as st and -alone treatments .
  The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients .
background: INTRODUCTION Erectile dysfunction ( ED ) is an increasing health problem that dem and s effective treatment .
  There is evidence that phosphodiesterase-5 inhibitors ( PDE5-Is ) and psychological intervention ( PI ) are effective treatment options ; however , little is known about their comparative efficacy and the efficacy of combined treatments .
  AIM The aim of this systematic review and meta- analysis is to evaluate the comparative efficacy of PI , PDE5-Is , and their combination in the treatment of ED .
  MAIN OUTCOME MEASURES Primary outcome was ED symptoms , and secondary outcome was sexual satisfaction of the patient .