July 21, 2007
Group therapy can help men with erectile dysfunction even if they are already using popular drugs like Viagra.
Group therapy could even be a feasible alternative to some treatments for impotence.
While the number of men studied overall was small, the reviewers found that group therapy appeared to be about as successful as suction devices and injections in terms of promoting erections. One analysis showed therapy worked for nearly two-thirds of participants.
The findings spotlight the importance of “integrating sex therapy and other psychological techniques into office practice” to help impotent patients, said lead author Tamara Melnik, professor of psychiatry at the University of São Paulo in Brazil.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Before the days of Viagra and its sibling drugs, many considered erectile dysfunction to be a difficult-to-treat psychological disorder. Now, drugs allow millions of men to achieve normal erections by allowing blood to flow more freely to the penis; the more serious side effects are rare.
However, drugs are not always an automatic cure for men with erectile dysfunction, especially those whose impotence relates to psychological factors.
A 2001 study of 115 impotent men found that psychological factors were responsible for the problems in 43 percent of the men and physical factors were responsible for problems in another 43 percent. In the rest of the men, researchers blamed impotence on a combination of mental and physical factors.
In the new review, Melnik and colleagues examined 11 studies from the last 32 years to compare the value of group therapy to other treatments such as oral drugs, injections and suction devices.
The review studies nearly 400 men: 141 received group therapy, 109 took drugs, 68 took drugs and took part in psychotherapy, 20 used “vacuum” (suction) devices and 59 were in control groups that did not receive any treatment.
Half of the men in the studies were from the United States and the average age of the men was 47.4 years.
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By pooling data from five of the studies, the researchers found that 36 of 55 men who took part in group therapy reported successful intercourse compared with 5 of 45 who were on waiting lists and had no treatment, Melnik said.
The researchers also combined data from two similar studies from 2000 and 2005 and found that men who took Viagra in conjunction with group therapy were more likely to report successful intercourse than those who took the drug alone.
The total number of men in the two studies was small — just 71.
The review authors did not find much difference in erection success rates between those who tried injections or suction devices and those who took part in group therapy alone.
According to Melnik, the goal of group therapy is to help men gain confidence and reduce anxiety. Most men feel comfortable in the setting of group therapy because they can share their difficulties with other men who have the same problem, Melnik said.
“Most people only wonder about the easiest and most rapid way to reach remission of erectile dysfunction,” Melnik said. “Group therapy takes more time than using medication, but in some cases dealing with psychological aspects is fundamental to achieving a successful outcome and maintaining the results.”
The review does not examine issues of cost nor how group therapy expenses compare to those of other treatments. The review authors did not look at the availability of group therapy for erectile dysfunction patients.
Hossein Sadeghi-Nejad, M.D., a New Jersey urologist, said psychological factors play a role in some cases of impotence. While drugs like Viagra can help people with erectile dysfunction caused by mental factors, the medications “do not work unless the patient is in the right frame of mind,” said Sadeghi-Nejad, director of the Center for Male Reproductive Medicine at Hackensack University Medical Center.
Indeed, while some people assume that Viagra and other drugs cause erections on their own, sexual stimulation is still necessary. Moreover, as generations of psychologists have discovered, mental issues can wreak havoc on a person’s sexual thoughts and sensations.
Sadeghi-Nejad added that stress, in particular, could cause problems and reduce the effectiveness of erectile dysfunction drugs
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