Erectile dysfunction: The medicalization of male sexuality

Erectile dysfunction (ED) is a highly prevalent disorder in males that increases markedly with aging. Diagnostic and treatment approaches for the disorder have proliferated in the past decade, along with increased understanding of the underlying physiology of male erection. Two specific themes have emerged in the recent literature on the topic: (a) erectile dysfunction is a socially legitimate, medically treatable problem, and (b) medical treatments are more reliable and effective than psychological interventions. This article reviews the efficacy and outcome data available for each of the major treatment approaches for ED, in addition to the risks and benefits associated with each approach. A variety of methodological issues are identified, including the lack of prospective study designs, inadequate assessment of sexual function, absence of long-term follow-up, and lack of attention to interactive effects of medical and psychological treatments. Although less widely publicized, cognitive-behavioral and interpersonal treatment approaches have been shown to be effective in a number of studies. Overall, there is a strong need for integration of medical and psychological approaches, in addition to increased outcome research in this area. Copyright (C) 1996 Elsevier Science Ltd