Price et al. used a comprehensive group ED treatment with men without partners that included a ban on intercourse, education about sexual response, sensate focus techniques, and other strategies to enhance sexual arousal and communication. They found improvement in erectile response, as well as enhanced “sexual self-image.” Treatment gains were maintained at a 6-month follow-up. Another study by this group examined the effectiveness of a group treatment that included education, group discussions, and communication skills training for men without partners who presented with ED. They also found a statistically significant decrease in reported erectile difficulties.
In a study of men with ED and their partners Goldman and Carroll used a group format that focused on: education about normal sexual response, enhancing the couple’s comfort and communication about sex, and increased acceptance of the partner’s sexual difficulties. The couples in the treatment group showed greater increases in sexual satisfaction than the control group.
A review of psychological treatments for ED involved a reexamination and meta-analysis of controlled studies over the past 30 years. The review included eleven studies that met the criteria for empirically sound clinical trials. Melnik and colleagues drew several conclusions based on the results of the review. First, groups receiving sex therapyfocused treatment showed greater efficacy for the treatment of ED than did the control groups receiving no treatment. Second, there were no clear differences in the outcome based on age, relationship status, or severity. However, men with secondary ED, i.e., those who had developed ED after a period of normal erectile function, tended to respond better to treatment than did men with primary (i.e., lifelong) ED. Third, studies that compared psychological treatment with vacuum pump devices and intracavernosal injections did not show clear differences between the two treatments, though both the medical and psychosocial treatments were found to be effective.
Finally, the reviewers also examined several studies which compared psychological treatment in combination with sildenafil with medication alone. The meta-analysis showed that men with ED randomized to the combined treatment showed significantly greater improvement and lower dropout rates than men with the medication alone.
A small study by Melnik compared the standard sex therapy approach to the treatment with sildenafil alone. This study found a statistically significant greater improvement in erectile function in the sex therapy group, which continued at the 3-month follow-up. There was also a significantly lower dropout rate in the psychological treatment group.
A number of studies of the outcome of sex therapy have included bibliotherapy, i.e., books that provide education and self-treatment strategies. Results suggest that book-based, self-help forms of treatment are a beneficial adjunct to medical or psychological treatment. There are several recommended books that have been writ-ten by respected sex therapists. Most therapists have found that treatment outcome is enhanced if both members of the couple are involved, though treatments for single men have also been found to be effective.
In sum, psychological treatments for ED have been demonstrated to be effective in group, couple, and individual treatment formats. Most of the studies have used an integrated sex therapy model that combines education, anxiety reduction, a temporary ban on sexual intercourse, enhanced communication and graduated steps of sexual activity. Heiman and Meston’s review of empirically validated treatment for sexual dysfunction offers support for some of the long-standing approaches to these disorders. Using the criteria of the American Psychological Association Task Force on empirically validated treatments, they found that psychological treatments were “well established” for erectile disorder in men. It remains unclear, which of these components of treatment is most effective, though most components have been shown to be effective by themselves. More research is needed to identify the most effective and efficient psychological approaches to the treatment of ED.