The success of Erectile Dysfunction treatment with Viagra

S1 Maximum success applied to men who, after taking Viagra on one or more occasions, did not need it thereafter to successfully engage in sexual intercourse. In addition, performance anxiety was reduced so that the man was able to confidently engage in sexual intercourse. Also, there were no complaints from the man’s partner.

S2 The next best category of success was drug dependent success which was defined as requiring Viagra in every case to be able to have satisfactory sexual intercourse. Without Viagra, sex was not possible.

S3, the third category of success, was defined as drug dependent success with the development of a new sexual symptom. This meant that initially sexual intercourse had been possible. Subsequently, however, either the man or his partner subsequently developed either some kind of dysfunction around desire, arousal, and orgasm or a symptom of pain on attempting intercourse.

S4, the lowest level of success was defined as improvement without intercourse. This means a man who developed an erection which was firm enough to have sexual intercourse also experienced some kind of psychological resistance that stopped intercourse from happening.

As far as failure was concerned, the first category of failure, F1, was transient and sustainable improvement. This was used to refer to men who regularly obtained a firm erection from the use of Viagra and for whom intercourse was in fact possible on occasion.

However, the erection was not valued enough by the couple for them to engage in sexual intercourse regularly, or they developed sexual aversion or some other symptom which precluded the possibility of sex altogether.

F2, the second category of failure was termed resistance failure and was applied to men or their partners who were simply not able to accept the drug as part of a treatment regime.

F3 Lastly, pharmacologic failure described a group who after dose adjustments and education about the method by which the drug should be used, simply did not have any improvement in erectile ability.

So what were the outcomes of this study in coping with erectile dysfunction, erection problems and impotence?

It was found that the Viagra combined with psychotherapy improved erections in two thirds of the men (this includes the success categories S1 – S4 and the first failure category F1). The first three success categories comprised 55% of the sample and they were able to have successful sexual intercourse.

Among the whole sample 52% had ideal outcomes, that is to say, they fell in success categories S1 and S2, and they were able to have intercourse regularly with out any new sexual symptoms developing. Of 30 men who had been diagnosed with psychogenic erectile dysfunction 73% developed improved erections and 53% were having successful intercourse.

Althof analysed the the ideal outcome (a combination of categories S1 and S2 at the first and second follow-up sessions). This provided an indication of the extent to which biopsychosocial factors can contribute to a man and/or his partner discontinuing a safe and effective treatment. These figures are in fact 52% and 43% respectively.

Use of Viagra as a therapeutic probe

Masters and Johnson developed the technique of sensate focus as a way to help both men and women overcome performance anxiety associated with sexual intercourse. However, it was quickly discovered that not all patients responded in the same way because psychological resistances of one kind or another interfered with the effectiveness of this treatment strategy.

After this was known, the purpose of sensate focus was adapted, and a move made towards using it as a way to  recognize psychological resistances. These could then be addressed with psychotherapy.

Althof draws a comparison between Viagra and sensate focus, suggesting that they have much in common.

For example, Viagra may facilitate the development of an erection but not enable intercourse: it can be a therapeutic probe which uncovers hidden reasons why a man or his partner (or both) stop using an effective treatment.

His proposed model of treatment is that the doctor, having prescribed Viagra, will subsequently enquire how well it worked in the creation of an erection, what the couple learned from this, and whether or not sex was successful.

This approach will enable both doctor and patient to explore the reasons why the patient is reluctant to use his erection for intercourse. This allows for discussion about emotional or physical blocks to the resumption of lovemaking.

Video – emotional blocks to lovemaking

This might include a high level of anger, resentment, or disappointment in the relationship. It’s often the case that one or other of the couple prefers an asexual equilibrium, or that the woman believes the man is responding to the drug rather than to her.

In either case, sexual psychotherapy is an approach which can explain and reduce the resistances. That way, the couple can cultivate a romantic atmosphere within the relationship. This will open lines of communication both physically and psychologically and so enable them to be comfortable with the idea of resuming sexual activity.

They may also need help to accept the inevitable changes which occur with age: the menopause, disability, illness, other sexual issues, or indeed the opening out of previously unacknowledged sexual variations. It’s certainly true that if these psychological impediments to intercourse are not addressed, even the best medical efforts will probably not work very well.

A combined treatment approach to erectile dysfunction in the future

Althof concludes his paper by stating that doctors require a means of assessing what a man or couple actually need before they treatment proceeds. This is because success is no longer simply able to be defined as a rapid and sustained erection.

In fact, Viagra clearly works well in restoring erectile capacity in simple cases where nothing more than a prescription and advice on how to use the drug are required. But the problem is that many cases of erectile dysfunction are not so straightforward. The ability to have sex and obtain sexual pleasure from intercourse are by no means assured with Viagra alone in many cases.

That’s when Viagra can function as a therapeutic probe and uncover issues for the man, his partner, the couple, and the context of their relationship.

In summary Althof lists these factors as likely to adversely affect the chances of successful resumption of sex:

• any issues of poorly managed or unresolved anger
• control and power issues
• contempt and disappointment.

These emotional or psychological factors may be complicated by the prolonged absence of sex from a relationship. Then, there certainly needs to be a psychological aspect to treatment of delay ejaculation addition to the pharmacological.

Furthermore, unrealistic expectations may surface: a man may believe that with his erection restored, sex will be more frequent or that he will feel more lovable and successful in life. If these expectations are not fulfilled, a man rarely says “I had unrealistic expectations”; he usually says that the “treatment with Viagra did not work”.

Remember also that Viagra requires a man to have sexual desire for his partner: any lack of sexual arousal will prevent him developing an erection. Viagra only allows an erection to develop when the man is aroused by his partner.

Viagra can reveal some challenging things: for example, it may reveal that a married man is secretly attracted to other men; that a man has no sexual desire for his partner; or that he has unusual or unconventional patterns of sexual arousal such as sadomasochism. All of these arousal patterns will interfere with the achievement and sustaining of an erection, and Viagra cannot be expected to overcome them.

Althof concludes his article by expressing the hope that combined treatments will become the rule rather than the exception. He suggests that treatment strategies need to be developed to determine what a couple really require.

This may be psychological intervention, pharmacological intervention alone, or combined pharmacological and therapeutic intervention. (A combined treatment for ED using medical and psychosocial approaches will require the involvement of both medical practitioners and psychosexual therapists.)