From the Guidelines
Management of erectile dysfunction (ED) caused by psychosocial factors primarily involves psychological interventions, lifestyle modifications, and sometimes medication, with a focus on addressing underlying anxiety, depression, relationship issues, or performance anxiety that may be contributing to ED.
Key Interventions
- Psychotherapy, particularly cognitive-behavioral therapy (CBT), is the first-line treatment to address underlying psychosocial issues 1.
- Sex therapy, either individually or with a partner, can help address specific sexual concerns and improve communication.
- Stress management techniques such as mindfulness meditation, progressive muscle relaxation, and regular physical exercise are also beneficial.
- For some patients, a short course of PDE-5 inhibitors like sildenafil (Viagra) 50mg, tadalafil (Cialis) 10mg, or vardenafil (Levitra) 10mg may be prescribed as needed to help restore confidence and break the cycle of performance anxiety, as recommended by the American College of Physicians 1.
Lifestyle Modifications
- Reducing alcohol consumption, quitting smoking, and maintaining a healthy weight can also improve erectile function, as suggested by the NCCN Survivorship Panel 1.
- Open communication with sexual partners about concerns and expectations is crucial for recovery.
Additional Considerations
- Treatment of psychosocial problems, with referral to sex and couples therapy as appropriate, can often alleviate symptoms of male sexual dysfunction, as noted in the study by Denlinger et al. 1.
- PDE5i treatment has been shown to improve the symptoms of ED and to be well tolerated, but it is contraindicated in patients taking oral nitrates due to the risk of a dangerous decrease in blood pressure 1.
- The timing and dose of on-demand PDE5i should be started conservatively, and it should be titrated to maximum dose if needed, with patients being monitored periodically for efficacy, side effects, and any significant change in health status 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Erectile Dysfunction Caused by Psychosocial Factors
The management of erectile dysfunction (ED) caused by psychosocial factors, such as stressors, involves a multidisciplinary approach that combines medical treatment with psychological interventions 2, 3, 4, 5.
- Psychological Interventions: Cognitive and behavioral techniques are used to reduce anxiety, challenge dysfunctional beliefs, increase sexual stimulation, disrupt sexual avoidance, and enhance intimacy and communication skills in a relational context 2.
- Partner Involvement: Including the partner in the assessment and treatment of ED is strongly recommended, as it can improve the quality of the sexual relationship and increase interpartner agreement and shared decision-making regarding treatment options 2, 4.
- Combination Therapy: Combining psychosocial interventions with medical therapy, such as pharmacologic therapy (e.g., sildenafil), is increasingly recommended, especially in cases of sexual initiation, low sexual desire, other sexual dysfunctions, and significant couples' or relationship problems 3, 5.
- Classification and Diagnosis: Psychogenic ED can be categorized as generalized or situational type, with subcategories of each type proposed, and a comprehensive diagnosis should include separate psychosocial interviews of the patient and partner 3, 4.
- Treatment Outcomes: A combination of psychological and physiological treatments can offer the best outcome for many cases of ED, and psychological interventions can improve medical treatments, patient adherence to treatment, and the quality of the sexual relationship 2, 4, 5.