Table 1.
Key features of psychosocial assessment and intervention in ED
| Assessment | Intervention | |
|---|---|---|
| Individual Factors | Relationship/Partner-related factors⁎ | Individual or with a partner (whenever possible) |
| Etiology from a multidisciplinary perspective: • Medical history • Medical evaluation to screen for vascular, neurologic, hormonal, or medication-induced ED |
Evaluation of co-existence of sexual dysfunction (primary or secondary to men's ED) | Integration of psychological and medical interventions |
| • Determination of specificity • primary vs secondary • situational vs generalized • psychogenic or mixed |
Partner's perception of severity and etiology of partner's ED | Build an atmosphere of trust and safety (good therapeutic alliance) |
| Psychosexual history (sexual development, sexuality education, sexual orientation, body image, history of abuse) | Couple's sexual history and skills | Target unrealistic expectations about treatment |
| Sexual distress and comorbidity with anxiety and depression | Emotional impact of partner's ED and attributions, including guilt, trustfulness and perceptions of self-attractiveness | Use an updated version of the PLISSIT model to guide intervention |
| Evaluation of sexual desire and subjective sexual arousal | Evaluation of couple's communication, sexual self-disclosure and conflict management | Psychoeducation |
| Evaluation of adequate stimulation | Evaluation of both partners’ sexual likes and dislikes | Anxiety reduction and desensitization |
| Sexual beliefs (eg, male performance beliefs) | Partner's own sexual beliefs (eg, about men´s sexual performance) | Cognitive Behavioral Therapy, (including third wave approaches such as mindfulness) Consider internet-delivered interventions |
| Attentional processes (eg, cognitive distraction, automatic thoughts) | Willingness to be involved in and expectations about treatment | Increasing sexual stimulation |
| Traits /personality factors (eg, perfectionism, negative affect, neuroticism) | Expanding on sexual quality instead of quantity and adjusting expectations (Good Enough Sex Model) | |
| Questionnaires, including a measure of distress | Include pleasure and/or satisfaction as treatment outcome | |
| Previous attempts to solve the problem, expectations about current intervention | ||
| Involvement of partner | ||
| Barriers to treatment: • Feeling embarrassed • Low self-confidence • Self and partner blaming • Feeling older • Communication problems between partners • Inaccurate information and limited understanding of ED • Stigma about ED • Unrealistic expectations about treatment |
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| Facilitators of treatment: • Desire to have sex • Partner's compliance • Awareness of treatment options and affordability of treatment |
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Notes: This table assumes distress associated with the experience of ED. This table centers on psychosocial factors and therefore excludes medical/organic factors. The authors acknowledge that a multidisciplinary integrative approach to ED is necessary.
⁎
These factors can be evaluated with the patient or, ideally, with the partner present.