Erectile Dysfunction Class 3 September 27, 2016 CSL 6794.01

Erectile Dysfunction Definition and Causes: Defined as the inability to achieve or maintain erection sufficient for sexual activity, ED occurs in approximately 10 % of men under 35 years of age and up to 50% of men over 60. Cardiovascular comorbidities; diabetes mellitus, and the metabolic syndrome have all been associated with ED in multiple cross-sectional and longitudinal studies.

Lifestyle factors, including smoking, obesity, and exercise, are also significant predictors of ED. A complex and often interactive set of variables and determinants can lead to ED Diagnosis of ED has historically been based on the self-reported ability of the man to achieve and maintain erection sufficient for sexual performance.

DSM 5 According to the DSM 5 definition of erectile disorder, at least one of three symptoms: Marked difficulty maintaining an erection Marked decrease in erectile rigidity, must have been present for a minimum duration of approximately 6 months and be expected on all or almost all occasions of sexual activity.

Psychological Issues to Assess Patient factors, such as performance anxiety or sexual inhibition Partner issues, such as low self-esteem or sexual performance problems Quality of the overall relationship Sexual and contextual variables, such as financial stresses and family dysfunction

The Assessment Model SELF – The self refers to all of the possible individual factors that a man experiencing ED is contributing to his sexual problem. PERFORMANCE ANXIETY – is the most common psychosocial factor and is inherent in most cases of ED. This term simply means a focus on performance rather than on the ongoing pleasure of sex.

COMORBID DISORDERS – In most cases of ED, when a severe comorbid mental health disorder is present, therapy must first address the comorbid disorder before addressing the ED. HISTORY OF NEGATIVE SEXULA MESSAGES – ED may be associated with a history of powerful negative sexual messages generated by family, culture, or religion.

SEXUAL ABUSE OR TRAUMA – The degree of impairment varies widely depending on the extent and duration of the abuse. GENDER IDENTITY, SEXUAL ORIENTATION, AND PARAPHILIA PROBLEMS – It is not unusual for some men to enter into sexual partnerships because of family expectations or social pressures…

MISINFORMATION AND LACK OF SEXUAL SKILLS – Men harboring sexual myths or misinformation who approach sex with an awkward narrow repertoire of sexual behaviors may be prone to ED. RELATIONSHIP/PARTNER – this may be one of the biggest issues in ED COUPLE CONFLICT

COUPLE STRESS UNRELATED TO CONFLICT – financial, work, health, children, etc. LACK OF SEXUAL ATTRACTION TO PARTNER – in some cases, the presence of ED is directly related to the lack of attraction that a man has toward his partner. PARTNER-RELATED SEXUAL AND NONSEXUAL PROBLEMS – emotional problems in the man or his partner.

ENVIRONMENT – An inquiry about the conditions under which sex occurs may identify interfering factors. Favorable conditions for sex usually include comfort, privacy, and relaxed times. LACK OF COMFORT – Comfort includes not only the physical comfort of the bed or surface on which sex occurs but the general surroundings as well. LACK OF PRIVACY – Feelings of lack of privacy have often been identified as factors contributing to ED.

LACK OF RELAXED TIME – Quality time together is limited by family, work, or other time interrupters.

TREATMENT FOR ED CLINICAL INTERVIEW SENSATE FOCUS – The senate focus approach developed by Masters and Johnson (1970) is still the cornerstone of treatment for most cases of ED. This procedure encourages couples to be orgasmic by any means other than intercourse

COGNITIVE BEHAVIORAL THERAPY - bibliotherapy and cognitive restructuring techniques are used to overcome sexual ignorance and to challenge the unrealistic sexual expectations that typically accompany ED. SEXUAL STIMULATION TECHNIQUES – helping the partner be orgasmic through manual and oral stimulation.