Guidelines for treating erectile dysfunction issued.

In contrast to the impressive advances made in somatic research of erectile dysfunction (ED), psychogenic ED is mostly treated as a monolithic block or is merely defined by exclusion of organic factors. This paper proceeds from the assumption that a classification of psychological subtypes of ED is urgently needed and has to include a categorization of different pathogenetic mechanisms as well as a classification of interaction patterns with somatic risk factors. After a brief review of current approaches, psychological subtypes of ED are examined along two different lines of evidence. First, 236 consecutive patients from an ED outpatient. unit were included in a cluster analysis to identify homogeneous subgroups of cases. Three clusters emerged, whose main characteristics as well as most important discriminating variables were further explored by various statistical procedures. Second, on the basis of clinical experience a four-level model of psychogenic ED is proposed that consists of dispositional, etiologic, pathogenetic, and maintaining factors. In addition, four different pathogenetic modes of psychogenic ED are differentiated, which have been labeled actual-neurotic, psychoneurotic, psychosomatic, and functional. Conclusions concentrate on these modes as well as on the empirical subtypes and their implications for clinical practice and future research. Our results indicate that we are just beginning to understand the complex pathogenic interface between psychological factors and manifest ED.

Erectile Dysfunction↗

PubMed1997

External vacuum therapy for erectile dysfunction: use and results.

This review assesses the continuing role of noninvasive vacuum therapy as treatment for erectile dysfunction and discusses the action of negative pressure in producing assisted erection. Through recent research in this area has centered on the development of pharmaceutical therapies, vacuum-therapy programs appear to be a consistent long-term option for patients experiencing either chronic or occasional impotence of any etiology. Very little testing is required before the initiation of vacuum treatment, and the overall; clinical success rate is approximately 90%. Significant success has been reported in more difficult patient populations, including those with veno-occlusive disorders and explanted penile prostheses. Vacuum therapy may also be used in conjunction with other therapies to enhance results. Contraindications to the use of vacuum therapy are few and primarily include patients with unexplained intermittent priapism and bleeding disorders. Side effects such as occasional numbness, pain, penile bruising, or petechiae have a low incidence. A recently reported survey of 5,847 vacuum users showed that 83.5% of patients continue to use the device for intercourse as desired. Patients should receive individual instruction in the use of these devices and should expect a learning or practice period to achieve optimal results. As newer treatments for erectile dysfunction gain increasing attention, it should be kept in mind that nearly every patient showing impotence of any degree or duration as well as patients who have failed other therapeutic choices are candidates for vacuum therapy.

Erectile Dysfunction↗