Pharmacotherapy in the Treatment of Male Sexual Dysfunction

Journal of Sex Research, August, 2000 by David L. Rowland, Arthur L. Burnett

Parallel outcomes on satisfaction appear with drugs that enhance erectile capacity. Men in whom intracavernosal (penile) injection induces strong erectile response typically report high levels of sexual satisfaction compared with less-responsive counterparts (Rowland et al., 1999). The use of oral medication such as sildenafil has also been associated with improved sexual satisfaction (Goldstein et al., 1998). Thus, to the extent that restored genital function and thus revitalized sexual activity have the potential to facilitate physical interaction and intimacy within couples, treatment of the dysfunctional mechanics of the genitals may impart significant psychological and interpersonal benefits to the patient and his partner.

Broader Psychological and Relationship Issues

Although the ease of pharmacotherapy has led to record numbers of men seeking treatment for their sexual problems, it has also underscored a tenet long held by sex therapists and counselors. Namely, although improved genital functioning and improved sexual/relationship satisfaction are often related, they are not synonymous. Indeed, this fact raises an important point regarding the desired outcome of any kind of therapy for a sexual problem--that of defining an appropriate endpoint and providing a treatment strategy that is most likely to achieve that endpoint. An implicit goal in the treatment of a "genital" dysfunction (PE or ED) is improved sexual satisfaction and perhaps even relationship satisfaction--indeed, restoration of genital function in the absence of these broader outcomes would seem pointless. Nevertheless, as sexual problems increasingly fall within the domain of medicine, the tendency to focus exclusively on genital outcomes may be augmented (Rowland, 1998; Teifer, 1996). This course of events is more likely to arise within a medical setting because of the strong attention given to the physical component of the problem by both the patient and the physician, sometimes to the exclusion of relevant psychological and interpersonal factors. Specifically, sexually dysfunctional men typically focus heavily on genital issues--the sexual problem is often seen as stemming from a hypofunctional penis, so the solution is identified as one that makes the penis functional once again (e.g., Zilbergeld, 1992). Moreover, physicians often assume their role is limited to the physical component of the problem and, although overall patient satisfaction is important to medical treatments, issues of general sexual satisfaction may not be addressed directly in the medical clinic. Likewise, medical personnel often feel unprepared professionally to address issues regarding the overall quality of the sexual interaction. Although understandable, such mindsets on the part of the patient and/or physician may overlook important psychological and relationship issues critical to optimizing sexual satisfaction within the dyadic relationship.

Indeed, for many couples, a sexual dysfunction may not only interfere with the sex act but also significantly alter the dynamics of the relationship (Hawton, 1998). To assume that correcting the genital problem will restore a healthy relationship dynamic ignores the negative fallout that might arise from the dysfunction (Lamberg, 1998). On the part of the patient, these may include a sense of inadequacy, diminished control, and a retreat from emotional and physical intimacy, with subsequent reactions on the part of the partner involving perceived loss of attractivity and desirability, loss of intimacy, and even frustration and anger. Negative consequences such as these may not be readily reversed by attending only to the genital problem--such situations may call for a more integrated treatment approach that addresses both the biological and psychosocial realms of the problem (e.g., Althof, 1995; Rowland, 1999).