Normal sexual answer is a biopsychosocial process and relies on the coordination of psychological endocrine vascular and neurological factors. Recent data show that psychological factors are involved in a substantial be of cases of (ED) alone or in combination with organic causes. However in contrast to the advances in somatic research of scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED.
To evaluate the effectiveness of psychosocial interventions for the treatment of ED compared to oral drugs local injection vacuum devices and other psychosocial interventions that may consider any psycho-educative methods and psychotherapy or both of any kind.
The following databases were searched to identify randomised or quasi-randomised controlled trials: MEDLINE (1966 to 2007). EMBASE (1980 to 2007) psycINFO (1974 to 2007). LILACS (1980 to 2007). DISSERTATION ABSTRACTS (2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2007). Besides this electronic search go across checking the references of all identified trials contact with the first compose of all included trials was performed in request to obtain data on other published or unpublished trials. Handsearch of the International Journal of Impotence Research and Journal of Sex and Marital Therapy since its first air and contact with scientific societies for ED completed the examine strategy.
Selection criteriaAll relevant randomised and quasi-randomised controlled trials evaluating psychosocial interventions for ED.
Data collection and analysisAuthors of the review independently selected trials open with the search strategy extracted data assessed trial quality and analysed results. For categorical outcomes the pooled relative risks (RR) were calculated and for continuous outcomes mean differences between interventions were calculated as well. Statistical heterogeneity was addressed.
Main resultsNine randomised (Banner 2000; Baum 2000; Goldman 1990; Kilmann 1987; Kockott 1975; Melnik 2005; Munjack 1984; Price 1981; Wylie 2003) and two quasi-randomised trials (Ansari 1976; Van Der Windt 2002) involving 398 men with ED (141 in psychotherapy group. 109 received medication. 68 psychotherapy plus medication. 20 vacuum devices and 59 hold back group) met the inclusion criteria. In data pooled from five randomised trials (Kockott 1975; Ansari 1976; determine 1981; Munjack 1984; Kilmann 1987) group psychotherapy was more likely than the control group (waiting list - a group of participants who did not acquire any active intervention) to reduce the be of men with “persistence of ” at post-treatment (RR 0.40. 95% CI 0.17 to 0.98. N = 100; NNT 1.61. 95% CI 0.97 to 4.76).
At six months go up there was continued maintenance of reduction of men with “persistence of ED” in favour of group psychotherapy (RR 0.43. 95% CI 0.26 to 0.72. N = 37; NNT 1.58. 95% CI 1.17 to 2.43).
In data pooled from two randomised trials (Price 1981; Kilmann 1987) sex-group psychotherapy reduced the number of men with “persistence of ” in post-treatment (RR 0.13. 95% CI 0.04 to 0.43. N = 37) with a 95% response rate for sex therapy and 0% for the hold back group (waiting list - no treatment) (NNT 1.07. 95% CI 0.86 to 1.44).
Treatment response appeared to differ between patient subgroups although there was no significant difference in improvement in erectile function according to mean group age type of relationship and severity of ED. In two trials (Melnik 2005; Banner 2000) that compared group therapy plus sildenafil citrate versus sildenafil men randomised to receive assort therapy plus sildenafil showed significant reduction of “persistence of ED” (RR 0.46. 95% CI 0.24 to 0.88; NNT 3.57. 95% CI 2 to 16.7. N = 71) and were less likely than those receiving only sildenafil to drop out (RR 0.29. 95% CI 0.09 to 0.93).
One small trial (Melnik 2005) directly compared group therapy and sildenafil change state. It found a significant difference favouring group therapy versus sildenafil in the mean difference of the IIEF (WMD -12.40. 95% CI -20.81 to -3.99. N = 20).
No differences in effectiveness were found between psychosocial interventions versus local injection and vacuum devices.
Authors’ conclusionsThere was evidence that group psychotherapy may improve erectile function. Treatment response varied between patient subgroups but focused sex-group therapy showed greater efficacy than control group (no treatment). In a meta-analysis that compared assort therapy plus sildenafil citrate versus sildenafil men randomised to receive group therapy plus sildenafil showed significant improvement of successful intercourse and were less likely than those receiving only sildenafil to drop out. assort psychotherapy also significantly improved ED compared to sildenafil change state alone. Regarding the effectiveness of psychosocial interventions for the treatment of ED compared to local injection vacuum.
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