Table 2.
Education and expectations: key educational messages, common myths and cognitive distortions in men with erectile dysfunction
| Key educational messages |
| PDE5 inhibitors are not ‘erectogenic’ agents per se. They are considered ‘contingent agonists’ of the sexual response and are hence effective only in the presence of sexual arousal/stimulation |
| Sufficient arousal and sexual stimulation are particularly important in elderly men, including those with diabetes, who may have increased sensory (tactile) thresholds (41,42) |
| PDE5 inhibitors are not always successful in restoring erectile function adequate for sexual intercourse on the first attempt. Each PDE5 inhibitor should be taken ≥ 4 times before it is deemed ineffective |
| Myths |
| It is the responsibility of the man to satisfy the woman |
| Size and firmness of the erect penis are necessary determinants of the female partner’s satisfaction |
| A woman’s favourite part of sex is intercourse |
| A man always wants and is always ready to have sex |
| With age, all men lose their ability to achieve erections |
| Cognitive distortions |
| All-or-nothing thinking, e.g. ‘I am a complete failure because my erection was not 100% rigid’ |
| Overgeneralisation, e.g. ‘If I had trouble getting an erection last night, I won’t have one this morning’ |
| Disqualifying the positive, e.g. ‘My partner says I have a good erection because she doesn’t want to hurt my feelings’ |
| Mind reading, e.g. ‘I don’t need to ask. I know how she felt about last night’ |
| Fortune telling, e.g. ‘I am sure things will go badly tonight’ |
| Emotional reasoning, e.g. ‘Because a man feels something is true, it must be’ |
| Categorical imperatives, e.g. ‘should’, ‘ought to’ and ‘must’ dominate the man’s cognitive processes |
| Catastrophising, e.g. ‘If I fail to achieve an erection tonight, my partner will abandon me’ |
Adapted with permission from Althof and Wieder (45). Adapted with kind permission from Springer Science+Business Media: Endocrine, Psychotherapy for erectile dysfunction: now more relevant than ever. Vol 23, 2004, page 132, Althof SE, Wieder M, Section IV. Permission also obtained from Althof SE