Prodi Ilmu Kedokteran Jiwa FK

RSUP Prof.DR.I.G.N.G Ngoerah

UNUD

A Psychosocial Approach to Erectile Dysfunction: Position

Statements from the European Society of Sexual Medicine
(ESSM)

JOURNAL READING
DR. FARIZA AYUSTAMA
 Introduction

Erectile dysfunction (ED) is one of the

most prevalent sexual disorders in men
and has therefore attracted much
research attention
 Psychological and social cause
is less considered anymore

phosphodiesterase type 5 inhibitors

(PDEi5) since the late 90s,
Method

A comprehensive literature search was conducted on the main

scientific databases

• (Pubmed, Web of Science, Psych Info, Medline, and Cochrane) using the following words
• Erectile dysfunction, erectile disorder, erectile difficulties, erectile problem, paired with psychogenic OR
psychological OR social OR interpersonal OR partner OR relationship OR intervention
• Publications up to February 2020 were included
 Psychological factor

A first important implication is that an Accordingly, ED may result from a lack of

adequate sexual stimulation or a limited sexual repertoire
sexual stimulus is needed to activate that has lost its arousing properties throughout
the sexual arousal the years
response
 Cognitive factors might also play a role in here and disrupt the
cascade of sexual arousal responding.

Men who experience

erectile difficulties enter a sexual situation
with high negative
affect and low positive affect, along with
negative expectations
about their sexual performance
• Cognitive distraction
• Negative automatic thoughts (eg, I am a failure, I need to perform, my erection is not firm
enough)
• macho-beliefs that involve unrealistic, unattainable expectations of male sexual performance
(eg, penile erection is essential for a woman’s sexual satisfaction, failing to get an erection may
result in the woman leaving me) may predispose men to get trapped into a vicious circle of
ED
A sexual response model based
on the models of Janssens et al,
2000.
Some research show that the patient with ED comes with certain
psychological issue :
• low of self-confidence
• negative self-schema’s
• negative body-image
• perfectionism
• neuroticism
• somatization
• anxiety
• depression
a meta-analysis Depression in ED
including 12 studies
Psychological Biological
and more than 14,000
• lower levels of energy • hypothalamic pituitary
participants followed • lack interest or motivation adrenocortical (HPA) axis

up to 10 years, showed anhedonia

• negative thoughts low self-
perturbation
• excess catecholamine release

that depression was confidence • serotonin production

impairment can cause poor
associated with a 70% cavernosal muscle relaxation
and sexual avoidance
increased risk of ED • most anti-depressants have
negative effects on erectile
and orgasmic function
 Social and Relational factor

• Difficulties to openly talk about sex and communicate about likes and dislikes may further increase
the negative sexual experiences

• In some cases, the use of PDE5 inhibitors may generate false beliefs regarding the possibility to have
an erection in all sexual occasions, beyond the partner’s seductive capacity

• It has been found that men with ED report lower levels of relationship satisfaction and more
relationship conflict than men without ED and that intimacy is an important correlate of sexual
satisfaction in men with ED

• It also important to consider the influence of media and societal expectations that create pressure on
the male sexual performance, thereby fueling machobeliefs, sexual myths, and unrealistic ideas
about the perfect intercourse model
 Psychological treatment on ED

• Counselling referring to providing support and guidance, raising awareness, and giving
limited advices with regard to specific (present) issues, so the patient can figure out
better ways to manage the ED
• Psychotherapy is directed towards gaining insights into chronic and recurrent emotional
and cognitive patterns, often established by past events, and how these may cause the
current problems
• Sex therapy can be regarded as a specific type of psychotherapy, focusing specifically on
sexual experiences.
CONCLUSION

The diagnosis, assessment, and treatment of ED needs to be approached

from a multidisciplinary perspective that takes into account the diverse
and biopsychosocial nature of erectile function
 CRITICAL APPRAISAL

Yes, the Author described the argument clearly by

i. Is the writing clear? Does the author’s writing style make his or
addressing etiology,diagnostic,psychological issues,
her argument clear, or does it create unnecessary confusion?
and the management of psychological in ED

ii. How strong is the author’s argument? Do the author’s main Yes, the argument was strong, adressing the importance
points back up the argument effectively? Is the argument logically of psychological issue of ED that have been forgotten in
organized? decade

Not Sure, but the author has mention the problem from the
iii. Are there indications of bias? Does the author mention all sides of an issue, or
medical causes and psychological causes and encourage not to
does he or she leave out important counter-arguments? What do you know about
dismiss each other
the author? Is there anything in the author’s background that might have caused
• the background of the author was vary and not only
bias?
psychologist and psychiatrist
iv. What are the author’s sources? Are they reliable? Does he or she
The sources was vary and up to 140 literature has been
use predominantly one type of source? Are the author’s sources
reviewed , and written appropriately
appropriate to his or her argument?

v. Which aspects of the author’s argument do you find most convincing? The most convincing aspects from the author was, the
Least convincing? relationship and social is influental in management for ED
TERIMAKASIH