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PubMed1998

[Erectile dysfunction: psychological causes, diagnosis and therapy].

For clinical practice, erectile dysfunction is the most important form of male sexual disorders. In the majority of patients causation and course of their erectile disorder is determined by a close interplay of somatic and psychosocial factors. This psychosomatic interaction has to be taken into account during diagnostic assessment and therapy. The old dichotomous concepts (psychogenic versus organic) of erectile dysfunction have to be replaced by multidimensional models that include dispositonal as well as chronifying factors. The main causes of psychogenic erectile disorders can be divided into three groups, each belonging to a different phase of time: 1. immediate factors (performance anxiety), 2. antecedent life events from recent history, 3. developmental vulnerabilities from childhood and adolescence. The most important instrument for the psychological evaluation of sexually dysfunctional patients is a comprehensive sexual history in which partner related aspects should be particularly focused. In treating psychogenic erectile dysfunctions sex therapy is a reliable and efficient treatment option with a reasonably good long-term prognosis. In future, sex therapy should be combined with somatic treatment options to reach a truly integrative approach to this complex disorder.

Adolescent↗

PubMed2000

Hypertension as a Risk for Erectile Dysfunction: Implications for Sildenafil Use.

Hypertension is one of several risk factors for erectile dysfunction. Others include the cardiovascular risk factors of low levels of high density lipoprotein, high total cholesterol, smoking, and diabetes. Certain antihypertensive drugs, especially the thiazide diuretics, can contribute to erectile dysfunction. Sildenafil is the first oral agent available for the treatment of erectile dysfunction. It works in patients with psychogenic as well as organic erectile dysfunction, including men with hypertension and men on antihypertensive medicines. Sildenafil alone causes small drops in systolic and diastolic blood pressure. When administered to patients on antihypertensive drugs it was again associated with small drops in arterial pressure and no increase in adverse events compared to patients not taking antihypertensive drugs. When sildenafil is given in the setting of organic nitrates (nitric oxide donors), large falls in blood pressure may occur. Sildenafil is absolutely contraindicated in the setting of organic nitrate use. (c)2000 by Le Jacq Communications, Inc.

Journal Article↗

PubMed1991

Mechanical devices for the treatment of erectile dysfunction.

Almost all men with erectile dysfunction can be successfully treated. External erection devices are safe and effective for the management of partial impotence. If external devices fail to produce adequate penile engorgement or if they cannot be used, invasive treatments are available. Penile implants remain the gold standard for the management of erectile impotence, especially complete impotence. A satisfaction rate of 80 to 90 percent can be expected with all of the currently available implants. Attention to surgical detail and proper patient selection usually produce an excellent functional and anatomic result.

Clinical Protocols↗

PubMed2002

Treatment of erectile dysfunction in patients with Peyronie's disease using sildenafil citrate.

Erectile dysfunction (ED) has frequently been associated with Peyronie's Disease (PD) and may further compromise coitus. This is a retrospective analysis of ED in patients with PD since the release of sildenafil citrate (SC) focusing specifically on our patients' responses to SC. One-hundred seventy six patients with PD were evaluated between April 1998 and May 2001. All patients received a complete medical and sexual history, physical exam, penile duplex ultrasound (PDU, with 30-90 mg of papaverine) to assess penile vascular integrity, plaque dimensions, and erect penile deformity. Based on these findings, appropriate treatment options were offered for their PD and their ED including SC, which was offered to 73 men. Patient response to SC was specifically assessed during patient office interview and via a mailed EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire. Seventy (39.8%) and 104 (59.1%) patients complained of decreased erectile capacity (ie rigidity) occurring before and after the onset of PD, respectively. Only two patients reported no change of erectile capacity. In all, 103 (58.5%) patients complained of significant reduction in sexual function due to diminished rigidity and sought treatment for their ED. Of the ED treatment options available, 73 (70.9%) patients were given a prescription for SC. Forty-eight (75.0%) patients returned the EDITS questionnaire while four of 73 (5.5%) patients did not fill their prescription and five of 73 (6.8%) did not engage in sexual activity following an initial trial of SC due to side effects (flushing, headaches). Based upon the EDITS response, 34 of 48 (70.8%) patients reported that they were either very satisfied or somewhat satisfied, five of 48 (10.4%) patients were neither satisfied nor dissatisfied, and nine of 48 (18.8%) patients were somewhat dissatisfied or very dissatisfied with the effectiveness of SC in enhancing their erectile response. No patient reported worsening of PD deformity or an increase in penile pain. The 30 patients who were not prescribed SC chose the following options to enhance rigidity: eight (7.8%) underwent prosthesis placement, four (3.9%) opted for vacuum constriction device (VCD), four (3.9%) chose intracorporal injections, and 14 (13.6%) used no adjunctive therapy. Erectile dysfunction is a problem associated with PD and all typical treatment options are acceptable. However, to our knowledge, there is no published study reviewing the efficacy of SC in patients with ED associated with PD. There appears to be no contraindication to using SC as being the least invasive and most convenient treatment option for ED with PD. Although the potential risk of coital trauma to the erect penis with PD is present, there is no evidence from this study that erections and coitus enhanced specifically by SC resulted in worsening deformity or progression of the PD. EDITS questionnaire results reveal that SC is an agent that allowed successful coitus in 70.8% of males with PD.

Arteries↗

PubMed2001

Sildenafil citrate for penile hemodynamic determination: an alternative to intracavernosal agents in Doppler ultrasound evaluation of erectile dysfunction.

OBJECTIVES: To suggest a new noninvasive method for penile Doppler ultrasound (PDU) evaluation of erectile dysfunction using oral sildenafil citrate as an erection induction agent. METHODS: A total of 20 patients admitted with the complaint of erectile dysfunction were evaluated by the short form of the International Index of Erectile Function. A total score of less than 25 was accepted as erectile dysfunction and PDU was performed. The initial penile study consisted of PDU examination under visual sexual stimulation (VSS), and the peak systolic velocity, end-diastolic velocity, and resistance index were recorded. Measurements of all the parameters were repeated on the same patients after intracavernosal papaverine, intracavernosal prostaglandin E(1) (PGE(1)), and oral sildenafil citrate administration, plus VSS. All patients had these four tests in the same order at weekly intervals. Sildenafil citrate was given orally 45 minutes before Doppler investigation, and patients had VSS during the waiting period. The patients were asked about their satisfaction and comfort after each test. Statistical analysis was performed using the Wilcoxon and Mann-Whitney U tests. RESULTS: The measurements with papaverine, PGE(1), and sildenafil citrate were significantly different from those after only VSS (P <0.008); however, the papaverine, PGE(1), and sildenafil citrate results were not different from each other according to the peak systolic velocity, end-diastolic velocity, and resistance index measurements (P >0.008). Patients commented that although PGE(1) was the strongest erectogenic agent, sildenafil citrate was the most convenient. CONCLUSIONS: Since the results of PDU with oral sildenafil citrate in association with VSS were not statistically different, we suggest a new noninvasive erection induction method for the purpose of PDU evaluation of erectile dysfunction.

Adult↗

PubMed2005

Sildenafil citrate treatment for erectile dysfunction after kidney transplantation.

OBJECTIVE: Our goal was to analyze the morbidity of organic erectile dysfunction (ED) in kidney-transplant patients and to evaluate the efficacy and reliability of sildenafil citrate treatment. METHOD: Sixty-five ED patients with normal graft function for 3 to 12 months after kidney transplantation were involved in our study. Erectile dysfunction was diagnosed in all the patients by the International Index of Erectile Dysfunction (IIEF). Among them, 10 patients were in light degree; 32 patients in moderate degree, and 23 patients in severe degree according to IIEF score. All of the patients underwent medical history, physical and chemical examinations. In each patient, the IIEF score, blood urea nitrogen, creatinine, and trough concentrations of cyclosporine were compared before and after taking sildenafil citrate at an initial dose of 50 mg every night. RESULTS: Twenty-six patients without ED before transplantation suffered ED after the operation, and 32 patients with ED before transplantation noticed worsening. Taking sildenafil citrate was effective in 53 patients (81.54%). There were no statistical differences in blood urea nitrogen, creatinine, or trough concentrations of cyclosporine in patients before and after sildenafil treatment. CONCLUSIONS: The morbidity of organic erectile dysfunction increased after transplantation. Sildenafil citrate treatment for ED in kidney-transplant patients was effective and safe. Graft function and trough concentrations of cyclosporine were not affected by sildenafil citrate.

Blood Urea Nitrogen↗

PubMed1997

The effect of parenteral testosterone replacement on prostate specific antigen in hypogonadal men with erectile dysfunction.

PURPOSE: Parenteral testosterone supplementation is a common treatment for erectile dysfunction in hypogonadal men. Despite its frequent use, the effect of testosterone on prostate specific antigen (PSA) in these patients has not been documented previously. In this study we determined the effect of parenteral testosterone replacement on PSA and PSA velocity in a group of men being treated for erectile dysfunction. MATERIALS AND METHODS: A retrospective analysis of 48 patients (mean age 65.9) was performed and 2 study groups were identified. Group 1 consisted of 27 patients with a serum PSA level before and after initiating testosterone replacement therapy, and group 2 consisted of 27 men with a minimum of 3 PSA measurements (intervals of 6 months or greater) while on testosterone replacement. Each man had erectile dysfunction, a normal digital rectal examination and a low or low-normal total serum testosterone level before initiating therapy. Testosterone replacement was discontinued if no subjective improvement in erectile function was obtained, or if prostate adenocarcinoma was suggested by digital rectal examination or PSA. RESULTS: The mean increase in PSA after initiating testosterone replacement was 0.29 ng./ml. representing a mean change of 37% from baseline (mean interval 12.8 months). The mean PSA velocity was 0.05 ng./ml. per year. Pretreatment testosterone level, age and testosterone dose did not independently alter the PSA during testosterone replacement. Eleven men required prostate biopsies during treatment. Biopsies were indicated for abnormal digital rectal examination in 10 men and an elevated PSA in 1. All biopsies were benign. CONCLUSIONS: Parenteral testosterone replacement in hypogonadal men with normal pretreatment digital rectal examination and serum PSA levels does not alter PSA or PSA velocity beyond established nontreatment norms. Thus, any significant increase in PSA or PSA velocity should not be attributed to testosterone replacement therapy and should be evaluated.

Aged↗

PubMed2003

Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction.

PURPOSE: We evaluated neurogenic erectile dysfunction, focusing on the post-radical prostatectomy model. We investigated changes in DNA, protein and apoptotic cells of the rat penis after denervation. Gross morphometry was measured to elucidate the impact of chemical changes. MATERIALS AND METHODS: Postpubertal male Sprague-Dawley rats were randomized to bilateral or unilateral cavernous nerve transection, or sham operation. Wet weight, DNA content and protein content were measured. Tissue sections were stained for apoptosis by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling and the apoptotic index was calculated. Dual staining was performed for endothelial and smooth muscle cells to identify apoptotic cells. RESULTS: Penile wet weight was significantly decreased at all time points after bilateral neurotomy (p <0.0005). Unilateral neurotomy allowed much greater preservation of penile weight. DNA content was significantly decreased in bilaterally denervated penes and unchanged in unilaterally operated penes. Protein content was not significantly altered in the bilateral or unilateral cohorts. Bilateral neurotomy induced significant apoptosis, while unilateral surgery caused significantly less apoptosis. Each population had apoptotic clustering just beneath the tunica albuginea, which was mostly smooth muscle cells. CONCLUSIONS: These data suggest the importance of neural integrity to maintain penile homeostasis. The loss in penile weight was consistent with the anecdotal experience of many clinicians. Decreased DNA content may have been due to significant levels of apoptosis in smooth muscle cells. Preserved protein content may suggest an increase in extracellular protein, as postulated in corporeal fibrosis. The subtunical population of apoptotic smooth muscle cells revealed a mechanism for veno-occlusive dysfunction observed after radical prostatectomy. These effects were significantly moderated in the unilateral model, reinforcing the critical nature of neural integrity.

Animals↗

PubMed2004

Erectile dysfunction in the cardiac patient.

Erectile dysfunction (ED) is a common problem in men over 40-50 years of age. Risk factors include: diabetes, lipid abnormalities, smoking, hypertension, obesity, and lack of physical activity. Oral phosphodiesterase-5 inhibitors appear effective and safe in most cardiac patients.

Cardiovascular Diseases↗

PubMed1999

Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group.

CONTEXT: Erectile dysfunction is common in men with diabetes. OBJECTIVE: To assess the efficacy and safety of oral sildenafil citrate in the treatment of erectile dysfunction in men with diabetes. DESIGN: A multicenter, randomized, double-blind, placebo-controlled, flexible dose-escalation study conducted May through November 1996. SETTING: Patients' homes and 19 clinical practice centers in the United States. PATIENTS: A total of 268 men (mean age, 57 years) with erectile dysfunction (mean duration, 5.6 years) and diabetes (mean duration, 12 years). INTERVENTIONS: Patients were randomized to receive sildenafil (n = 136) or placebo (n = 132) as needed, but not more than once daily, for 12 weeks. Patients took the study drug or placebo 1 hour before anticipated sexual activity. The starting dose of sildenafil citrate was 50 mg, with the option to adjust the dose to 100 mg or 25 mg based on efficacy and tolerability, to be taken as needed. MAIN OUTCOME MEASURES: Self-reported ability to achieve and maintain an erection for sexual intercourse according to the International Index of Erectile Function and adverse events. RESULTS: Two hundred fifty-two patients (94%) completed the study (131/136 in the sildenafil group, 121/132 in the placebo group). By intention-to-treat analysis, at 12 weeks, 74 (56%) of 131 patients in the sildenafil group reported improved erections compared with 13 (10%) of 127 patients in the placebo group (P<.001). The proportion of men with at least 1 successful attempt at sexual intercourse was 61 % (71/ 117) for the sildenafil group vs 22% (25/114) for the placebo group (P<.001). Adverse events related to treatment were reported for 22 (16%) of 136 patients taking sildenafil and 1 (1%) of 132 patients receiving placebo. The most common adverse events were headache (11% sildenafil, 2% placebo), dyspepsia (9% sildenafil, 0% placebo), and respiratory tract disorder (6% sildenafil, 2% placebo), predominantly sinus congestion or drainage. The incidence of cardiovascular adverse events was comparable for both groups (3% sildenafil, 5% placebo). CONCLUSION: Oral sildenafil is an effective and well-tolerated treatment for erectile dysfunction in men with diabetes.

Adult↗

PubMed1997

Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group.

BACKGROUND: Erectile dysfunction in men is common. We evaluated a system by which alprostadil (prostaglandin E1) is delivered transurethrally to treat this disorder. METHODS: Alprostadil was delivered transurethrally in a double-blind, placebo-controlled study of 1511 men, 27 to 88 years of age, who had chronic erectile dysfunction from various organic causes. The men were first tested in the clinic with up to four doses of the drug (125, 250, 500, and 1000 microg); those who had sufficient responses were randomly assigned to treatment with either the effective dose of alprostadil or placebo for three months at home. RESULTS: During in-clinic testing, 996 men (65.9 percent) had erections sufficient for intercourse. Of these men, 961 reported the results of at least one home treatment; 299 of the 461 treated with alprostadil (64.9 percent) had intercourse successfully at least once, as compared with 93 of the 500 who received placebo (18.6 percent, P<0.001). On average, 7 of 10 alprostadil administrations were followed by intercourse in men responsive to treatment. The efficacy of alprostadil was similar regardless of age or the cause of erectile dysfunction, including vascular disease, diabetes, surgery, and trauma (P<0.001 for all comparisons with placebo). The most common side effect was mild penile pain, which occurred after 10.8 percent of alprostadil treatments, but the pain rarely resulted in refusal to continue in the study. Hypotension occurred in the clinic in 3.3 percent of men receiving alprostadil. Hypotension-related symptoms were uncommon at home. No men had priapism or penile fibrosis. CONCLUSIONS: In men with erectile dysfunction, transurethral alprostadil therapy resulted in erections in the clinic and in intercourse at home.

Adult↗

PubMed2004

Role of sildenafil citrate in treatment of erectile dysfunction after radical retropubic prostatectomy.

BACKGROUND: Sildenafil citrate was introduced as a treatment for erectile dysfunction in April 1998 in the United States and has been available since March 1999 in Japan. In this article, we assess the efficacy of sildenafil in the treatment of erectile dysfunction in Japanese men after radical retropubic prostatectomy for localized prostate cancer. METHODS: Of 106 men who underwent radical retropubic prostatectomy between January 1994 and March 2000, 43 were prescribed sildenafil at their request after radical retropubic prostatectomy. Medication was initiated at 25 mg, and if this was ineffective, the dose was increased to 50 mg. Of the patients, 18 underwent bilateral and 21 unilateral nerve sparing (NS) procedures, while in 4 patients, a non-NS procedure was performed. These patients were interviewed using a questionnaire about their response to sildenafil and using the 5-item International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: Thirty-three of the 43 patients were eligible for evaluation of the efficacy of sildenafil and 27 completed the IIEF-5 questionnaires. Sildenafil at 50 mg had a better effect on sexual function than 25 mg in most Japanese patients. Of the 16 patients who underwent bilateral NS procedures, 10 (62.5%) had improved ability for intercourse and 3 (18.8%) had improved erections. Of the 13 patients who underwent unilateral NS procedures, 7 (53.8%) had improved ability for intercourse and 4 (30.8%) had improved erections. None of the 4 patients who underwent non-NS procedures had a positive response. Of 24 patients with positive response to sildenafil, 3 (12.5%) did not have to take sildenafil after receiving it because they did not require it for intercourse. Mean IIEF-5 score increased from 4.3 to 11.4 (P < 0.0001). Patient age, time since surgery, PSA and pathological stage did not have statistically significant effects on outcome. The most commonly cited adverse effect was headache (21%). CONCLUSION: Sildenafil is equally effective for erectile dysfunction in Japanese patients who have undergone bilateral and unilateral NS procedures, and aids recovery of natural erectile function after radical retropubic prostatectomy. However, non-NS procedure patients had no response to sildenafil. This study suggested that sildenafil is well tolerated and should be initially used for treatment of Japanese men with erectile dysfunction after radical retropubic prostatectomy.

Aged↗

PubMed1999

[Neurophysiologic techniques in the diagnosis of erectile dysfunction: study of 105 cases].

OBJECTIVE: To present the results of the neurophysiological diagnostic evaluation in patients with erectile dysfunction. METHODS: 105 consecutive patients with complaints of erectile dysfunction were evaluated. The patients were divided into five groups according to their history: surgery/trauma, diabetes, vascular disease, toxicity, and no antecedents. Neurophysiological examination, laboratory tests, hormone and vascular studies were performed. Patient evaluation included neurophysiological studies on nerve conduction velocity (NCV), bulbocavernosus reflex (BCR), spinal and scalp somatosensory evoked potentials from the posterior tibial nerves (SEPt) and from the dorsal penile nerve (SEPp). In selected cases, electromyography and neuroimaging studies were done. RESULTS: 71 patients (67.62%) showed organic alterations; 57 of these patients had abnormal neurophysiological tests. Ranked in order of incidence, the tests were abnormal for NCV in 46/105 patients, SEPt 37/105, BCR 35/105 and SEPp in 30/105 patients. The incidence of BCR abnormalities was higher than that of the NCV only in the surgery/trauma group, probably due to a higher prevalence of local injuries, while NCV showed the highest incidence of abnormal results in the other groups of patients. Only 8 patients showed normal NCV with abnormal BCR, SEPp and/or SEPt (14.04% of patients had neurophysiological disturbances). CONCLUSION: In this study, most of our patients showed vascular, neurologic or both abnormalities, and were rarely associated with other factors. In our view, NCV is the technique of choice in the assessment of neurological disorders in patients with erectile dysfunction, whereas the other less sensitive tests are considered to be indicated basically in erectile dysfunction highly suspected as having an underlying neurogenic cause.

Adult↗

PubMed2001

Erectile dysfunction and cardiovascular risk factors.

Erectile dysfunction (ED) affects as many as 30 million men in the United States. Its risk factors are similar to those for atherosclerotic heart disease. Physicians should ask male patients--particularly those with cardiovascular disease--about ED and men with confirmed ED about cardiovascular risk factors. Oral sildenafil is an effective therapy for both organic and psychogenic ED; it is contraindicated in patients taking organic nitrates.

Cardiovascular Diseases↗

PubMed1980

Biofeedback and facilitation of erection in men with erectile dysfunction.

Thirty men with psychogenic erectile dysfunction were instructed to concentrate on cognitions that facilitate erection during one baseline and four training sessions. The subjects were divided into three groups that received either continuous feedback of erection changes plus segments of erotic film delivered contingent on erection increases, contingent film segments without continuous feedback, or noncontingent film segments. Although subjects who received noncontingent film segments initially showed greater erection increase than did subjects in the contingent feedback groups, the groups did not differ by the final training session. However, when subjects were instructed to facilitate erection without the aid of feedback or film segments during evaluation trials that followed each training session, subjects who had received contingent film without continuous feedback showed greater erectile responsivity than subjects in other groups. The groups did not differ in the amount of clinical improvement shown on self-report measures concerning erectile functioning during a 1-month follow-up period. Although these results indicate that the provision of erotic film feedback enhances the voluntary facilitation of erection in the laboratory, the therapeutic value of erectile feedback remains undemonstrated.

Adolescent↗

PubMed1999

The use of iliac bone flap as a penile stiffener in a diabetic patient with erectile dysfunction.

A diabetic man with erectile dysfunction in whom two previous attempts at penile prosthesis implantation had failed was treated by using an iliac bone flap as a penile stiffener. The patient had satisfactory sexual function with his penis; it retained its size and stiffness during the 1-year follow-up period. We recommend this method for use in patients in whom multiple earlier attempts at penile prosthesis implantation were unsuccessful.

Adult↗

PubMed2000

Erectile dysfunction in patients with spina bifida is a treatable condition.

PURPOSE: Now that individuals with spina bifida live well into adulthood erectile dysfunction has become a recognized associated medical disorder. To our knowledge no study has dealt specifically with treatment of erectile dysfunction in men with spina bifida. Therefore, we conducted a prospective, blinded, randomized, placebo controlled, dose escalation, crossover study to determine the ability to treat erectile dysfunction in men with spina bifida with sildenafil citrate. MATERIALS AND METHODS: Erectile dysfunction was diagnosed in 15 men 19 to 35 years old with spina bifida who were assigned to take 4 sets of tablets, 5 tablets per set, in a random order. All patients took 25 and 50 mg. sildenafil and 2 identical looking sets of corresponding placebos 1 hour before planned sexual activity. Efficacy was assessed by the effect of treatment compared to baseline, that is before treatment, on rating of erections (scored from 0 to 10), duration of erections, frequency of erections based on response to question 1 (scored from 0 to 5) of the International Index of Erectile Function and confidence to obtain an erection based on response to question 15 (scored from 1 to 5) of the International Index of Erectile Function. RESULTS: Improved erectile function was reported while on sildenafil by 12 (80%) men compared to baseline and placebos. There was a significant dose dependent improvement of erectile function with both 25 and 50 mg. sildenafil compared to baseline (p <0.05), as mean erectile score increased by 50% and 88%, mean duration of erections increased by 192% and 266%, mean frequency of erections increased by 61% and 96%, and mean level of confidence increased by 33% and 63%, respectively. Furthermore, 50 mg. sildenafil provided greater improvement in all 4 parameters compared to 25 mg. The placebo results were not significantly different compared to baseline for any of the parameters. CONCLUSIONS: Erectile dysfunction in patients with spina bifida is a medically treatable condition. Sildenafil is effective in this patient population and improves level of sexual confidence.

Adult↗

PubMedDate not supplied

Cognitive changes predict continued recovery of erectile functioning versus relapse after discontinuation of sildenafil treatment for male erectile dysfunction.

OBJECTIVE: To examine whether erectile functioning after termination of sildenafil intake in men with psychogenic ED (erectile dysfunction) can be predicted with psychological measures. METHOD: The subjects in a nonrandomized controlled trial were 65 heterosexual men with acquired psychogenic ED, aged 54.2 +/- 11 years. Sildenafil medication was taken as required before sexual activity, up to two times per week. Response to a global end point question ("Did the treatment you took during the study improve your physical response during sexual activity in the last 4 weeks?") was recorded after 6 weeks of sildenafil use and, subsequently, 6 weeks without medication. Other measures of sexual functioning and cognitive predictor measures were also administered. RESULTS: Of the 65 participants who commenced sildenafil treatment, 37% withdrew from the study before follow-up assessment. At posttreatment, 89% of participants reported that treatment had improved or cured their erectile functioning. At follow-up, 66% of participants had maintained posttreatment gains. Response at follow-up could be predicted (p <.001) with 96% sensitivity and 50% specificity by entering changes in sexual self-confidence and the participant's rating of his partner's wish to continue treatment in a logistic regression model. Higher odds for recovery of erectile functioning were found in participants reporting increased sexual self-confidence and the estimation that their partner wanted them to continue sildenafil use. High pretreatment sexual desire was found to further increase the odds for positive responding at follow-up. CONCLUSIONS: The present results indicate that continued improvement of erectile functioning is possible after discontinuation of sildenafil use in men with psychogenic ED. Maintenance of gains can be predicted from cognitive changes before medication is withdrawn.

Adolescent↗