A psychosocial approach to erectile dysfunction: Position statements from the European Society of Sexual Medicine (ESSM)

Marieke Dewitte*, Carlo Bettocchi,, Joana Carvalho, Giovanni Corona, Ida Flink, Erika Limoncin, Patricia Pascoal, Yacov Reisman, J.J.D.M. van Lankveld

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction
Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far.

Aim
To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM).

Method
A comprehensive, narrative review of the literature was performed.

Main outcome measures
Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided.

Results
A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable.

Conclusion
Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect.
Original languageEnglish
Article number100434
Number of pages15
JournalSexual Medicine
Volume9
Issue number6
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Erectile Dysfunction; Sexology; Psychotherapy; Biopsychosocial
  • Erectile Dysfunction
  • COMMITMENT THERAPY
  • MENS ATTITUDES
  • 5 INHIBITORS
  • EFFICACY
  • INTERNATIONAL INDEX
  • Psychotherapy
  • WOMEN
  • FEMALE PARTNERS
  • Sexology
  • Biopsychosocial
  • QUALITY-OF-LIFE
  • HEALTH
  • PERSONALITY-TRAITS

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