The question “which should be first?” in treating male sexual dysfunction (MSD) was recently discussed by experts in the Journal of Sexual Medicine.
In a “Controversies in Sexual Medicine” article, Dr. Emmanuele A. Jannini of the University of L’Aquila in Italy invited experts to address three specific areas:
• use of testosterone and/or phosphodiesterase type 5 inhibitors (PDE5s) to treat hypogonadal men with erectile dysfunction (ED)
• treatment of premature ejaculation (PE)
• the roles of counseling and psychotherapy in MSD treatment
Dr. Andrea M. Isidori and Dr. Andrea Lenzi, both of the “Sapienza” University of Rome, responded to the first topic. They explained that the choice of treatments for hypogonadal men with ED largely depends on the specific diagnosis.
In some cases, carefully-monitored testosterone treatment alone may be enough, especially if men are younger. If a man’s erections do not improve with testosterone treatment, adding a PDE5 can be considered. In other cases, such as with older men, sexual function should be restored first with a PDE5, with testosterone added later if necessary.
Dr. Antonio Aversa, also of the “Sapienza” University of Rome, joined Dr. Lenzi in the discussion of PE treatment. They recommended looking at the patient’s situation, such as his relationship, lifestyle, and the presence of any anxiety or depression disorders, before considering medical treatment.
Psychological issues can greatly affect premature ejaculation, they noted. However, other conditions like ED, prostatitis, urethritis, and the use of prescription and recreational drugs are other important considerations. Once a cause can be pinpointed, treatment decisions can be made.
Finally, Dr. Stanley E. Althof of Case Western Reserve University School of Medicine in Florida, USA discussed whether pharmacotherapy or psychotherapy should be used to treat men or women with sexual dysfunction.
He explained that psychotherapy can complement medical therapy and cited past research, which has shown that for men with ED and PE, combined psychological and medical treatment is more effective than medical treatment alone.
“The most compelling argument to practice in a biopsychosocial manner is that almost every patient is affected, both psychologically and interpersonal, by their sexual dysfunction even when the cause of the dysfunction is predominantly organic,” he wrote.
Men and women who have success with medical treatments see changes in their relationship, which counseling can address, he added.
Summing up all three areas of discussion, Dr. Jannini concluded that, “Intuition, experience, and available evidence should guide the choice of which treatment to use first. This decision is highly critical in influencing the therapeutic outcome as well as the patient’s and couple’s adherence.”
Resources
The Journal of Sexual Medicine
Jannini, Emmanuele A., MD, et al.
“Which Is First? The Controversial Issue of Precedence in the Treatment of Male Sexual Dysfunctions”
(Full-text. First published online: October 7, 2013)
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12315/full