Psychotherapy and Pharmacotherapy for Sexual Dysfunctions

Well-controlled (Type 1 and Type 2) investigations have demonstrated the efficacy of psychological interventions for erectile dysfunctions. However, when the oral agent sildenafil was approved by the Food and Drug Administration in 1998, its introduction was nothing short of dramatic. Sildenafil is a phosphodiesterase Type 5 inhibitor (PDE 5) that enhances the man’s ability to achieve a natural erection given adequate psychic and physical stimulation. Unlike other interventions, such as self-injection, transurethral, or vacuum therapy, sildenafil does not induce erection irrespective of the man’s degree of arousal. Although myths abound, sildenafil does not improve libido, promote spontaneous erections, or increase the size of the penis. The efficacy of sildenafil has been demonstrated in Type 1 multiple double-blind, placebo-controlled, multicenter studies. A large number of placebo-controlled, double-blind studies have demonstrated that fluoxetine, sertraline, clomipramine, and paroxetine can be used to delay ejaculatory latency in men with rapid ejaculation. Since the early 1970s, an array of individual, conjoint, and group therapy approaches employing behavioral strategies such as stop-start or squeeze techniques have evolved as the psychological treatments of choice for rapid ejaculation, although the impressive initial posttreatment success rates, ranging from 60 to 95%, are not necessarily sustainable; three years after treatment, success rates dwindle to 25%.