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Erectile Disorder Description
The sexual dysfunction from the DSM-5 is an erectile disorder is 302.72 (F52.21). According to American Psychiatric Association (2013), at least one of the three following symptoms must be present on substantially all, if not all, occasions of sexual activity, roughly 75-100 percent. The initial symptom is significant trouble maintaining an erection during sexual intercourse. The second symptom is considerable difficulty retaining an erection until sexual activity is completed. Finally, erectile dysfunction is characterized by a significant reduction in erectile rigidity. American Psychiatric Association (2013) suggests that a thorough sexual history is required to ensure that the problem has been persistent for an extended period, such as at least six months, and that it happens on most sexual occasions. Many men with erectile dysfunction have poor self-esteem and self-confidence and a diminished feeling of masculinity and may experience depression (American Psychiatric Association, 2013). It is possible that fear and avoidance of future sexual experiences may ensue; reduced sexual pleasure and desire in the individual’s partner are prevalent.
The prevalence of lifelong versus acquired erectile dysfunction is unclear. Based on the DSM-5, there is a significant age-related rise in the prevalence and severity of erection issues, particularly beyond the age of fifty (American Psychiatric Association, 2013). For instance, approximately 13 to 21 percent of males between the ages of 40 and 80 report occasional erection issues. Roughly 2 percent of men under the age of 40-50 years report common erection issues, but 40 to 50 percent of men over 60-70 years may have major sexual problems. Roughly 20 percent of males dread erectile problems before their first sexual encounter, whereas approximately 8 percent had erectile problems that prevented penetration during their first sexual encounter.
There are no genetic/family patterns in erectile dysfunction. It has been indicated that having sex with a previously unknown partner, concurrent use of drugs or alcohol, not desiring to have sex, and societal influence contribute to erectile failure on the first sexual try (American Psychiatric Association, 2013). Nonetheless, the natural history of lifelong erectile dysfunction is uncertain. Clinical evidence supports the link between lifelong erectile dysfunction and psychological characteristics that are self-limiting or sensitive to psychological therapies (American Psychiatric Association, 2013). Consequently, acquired erectile dysfunction is more likely to be caused by biological reasons and chronic, and erectile dysfunction increases with age. According to DSM-5, most erectile dysfunction complaints vary by country (American Psychiatric Association, 2013). It is unknown how much of the variation is due to cultural expectations.
Treatment
Essentially, various treatments for erectile dysfunction are available. Retzler (2019) argues that significant stress, marital problems, depression, anxiousness, and post-traumatic stress disorder are all factors that might lead to erectile disorder. The most often used pharmacological therapy for erectile disorder is phosphodiesterase type 5 inhibitors (PDE5i) (Retzler, 2019). According to Guillén et al. (2020), sublingual apomorphine may be an alternative for individuals with erectile dysfunction who cannot use phosphodiesterase type 5 inhibitors, such as nitrates. Sublingual apomorphine is now the only authorized oral medication for erectile dysfunction that is not contraindicated with the use of nitrates (Guillén et al., 2020). Beecken et al. (2021) state that PDE5I is a potent erectile dysfunction treatment agent. Nevertheless, the often-positive main therapeutic effect should not conceal the possibility of simpler, less expensive, and equally effective therapies with fewer side effects.
For instance, with or without PDE5I, multifactorial therapy may be employed to boost the impact and possibly improve therapeutic adherence. Comprehensive meta-analyses show that lifestyle changes have a favorable influence on erectile function in males (Beecken et al., 2021). The most challenging aspect of this long-term treatment approach is maintaining the altered lifestyle. Thus, it is critical to have a comprehensive treatment strategy for erectile disorder since it is more likely to be helpful than utilizing a single drug to treat merely symptoms. Retzler (2019) claims that some men with ED may benefit from referrals to cognitive behavioral therapy, stress management, or couple’s counseling. Group therapy has also been shown to enhance erectile function. To reverse ED caused by regular pornography usage, the patient must abstain from all pornography, pornography replacements, and, in general, any artificial sexual excitement (Retzler, 2019). In specific individuals, physical treatment “to strengthen the bulbocavernosus and ischiocavernosus muscles and connective tissue” can successfully alleviate the dysfunction (Retzler, 2019, p. 7). Pelvic floor muscles, which play a role in erection maintenance, diminish with age.
Personal Reflection
Working with clients who have erectile disorder necessitates a careful assessment of psychological factors that may impact patients’ lifestyles. According to Gallo et al. (2020), PDE5 inhibitors (PDE5is) are presently the first-line therapy for any kind and cause of the erectile disorder. Many scientific studies have shown that an unhealthy lifestyle characterized by cigarette smoking, excessive alcohol use, poor food, poor sleep quality, and a lack of exercise has a long-term impact (Beechen et al., 2021). I entirely agree that lifestyle change, exceptionally tailored physical activity, is an essential aspect of the therapy of erectile dysfunction and should be discussed and encouraged to the patient in all circumstances.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th Edition: DSM-5. American Psychiatric Publishing.
Beecken, W.-D., Kersting, M., Kunert, W., Blume, G., Bacharidis, N., Cohen, D. S., Shabeeh, H., & Allen, M. S. (2021). Thinking about pathomechanisms and current treatment of erectile dysfunction – “The Stanley Beamish Problem.” Review, recommendations, and proposals. Sexual Medicine Reviews, 9(3), 445–463.
Gallo, L., Pecoraro, S., Sarnacchiaro, P., Silvani, M., & Antonini, G. (2020). The daily therapy with t-arginine 2,500 mg and tadalafil 5 mg in combination and in monotherapy for the treatment of erectile dysfunction: A prospective, randomized multicentre study. Sexual Medicine, 8(2), 178–185.
Guillén, V., Rueda, J.-R., Lopez-Argumedo, M., Solà, I., & Ballesteros, J. (2020). Apomorphine for the treatment of erectile dysfunction: Systematic review and meta-analysis. Archives of Sexual Behavior, 49(8), 2963–2979.
Retzler, K. (2019). Erectile dysfunction: A review of comprehensive treatment options for optimal outcome. Journal of Restorative Medicine, 8(1), 1-19.
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