Erectile disorder

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Click here to download tool kit including information related to the assessment and treatment of erectile disorder, which is characterized by a recurrent inability to achieve or maintain a satisfactory erection during partnered sexual activities (American Psychiatric Association, 2013). It is the most common issue that I see in my practice. Information about assessments, scholarly articles, and websites will be provided with a brief description of each.
Assessments
International Index of Erectile Function (IIEF-5) (Rosen et al., 1999)
This assessment is the most widely used in assessing the presence of Erectile Disorder (ED) (Kapoor & Kapoor, 2016; Silva, Sousa, Azevedo, & Martins, 2016). It allows for rapid clinical assessment of ED and can measure the effectiveness of ED treatments (Rew & Heidelbaugh, 2016). The full version has 15 self-reported questions while the short version contains 5 items. Both versions have been validated in research and translated into many languages (Heidelbaugh, 2010). More recently, the test has been adapted for use with men who have sex with men (Coyne et al., 2010). The five-question version is often referred to as the Sexual Health Inventory for Men. This test is useful because it can quickly identify if a client meets the threshold for a possible diagnosis of ED. Click on the link above for this test.
Sexual Quality of Life-Male (SQOL-M) (Abraham, Symonds, & Morris, 2008)
            This test was developed by researchers associated with Pfizer (the maker of Viagra) to investigate the sexual quality of life for men with premature ejaculation (PE) or erectile dysfunction (ED). It contains 11 items which load onto one factor labelled emotional well-being. It was validated with men with PE, ED, and without sexual dysfunction. It has been translated into 9 languages and is used to measure the effects of treatment on sexual quality of life. I have not used this assessment but have used the female version of this test for other purposes. However, it may be useful to use as I am treating a client with this disorder to see if there is a benefit from treatment.
Self Esteem and Relationship Questionnaire (SEAR) (Cappelleri et al., 2012)
            This test is a validated, 14-item self report measure used to assess Erectile Dysfunction treatment effectiveness in relation to psychosocial benefits. There are 5 components and an overall score. Items are scored on a 5-point Likert scale with higher scores indicating better outcomes, divided into sexual relationship satisfaction, confidence, self-esteem, and overall relationship satisfaction subscales. This test can aid an assessment of ED in terms of other dimensions of sexual improvement not necessarily related to diagnosis. Like the SQOL-M, this test does not measure diagnostic strength, but rather assesses how a client is doing with their erections based on factors related to how they feel about themselves and their relationships. I would consider using this test to assess if my treatment is working for a client.
Intersystems Approach (Gambescia & Weeks, 2015)
            This assessment is not a standardized test like the above tests, as it is more of an approach to comprehensively assess the major dimensions of sexual dysfunction. The five major components are individual biological issues (medical history, health status, physical strengths, illnesses, and physical changes), individual psychological factors (traits, tendencies, diagnoses, strengths, diagnoses, disorders, and developmental stages), interactional dynamics (relationship factors, vulnerabilities, communication patterns, conflict resolution skills, and intimacy), family of origin influences (what each individual learned about in terms of messages about sexuality, gender, sexuality, and shame), and environmental considerations (the person’s sociocultural norms, beliefs, preferences, and values). The foundation of this assessment and intervention of ED is a comprehensive sex history.
Scholarly Articles
Montague, D. K., Jarow, J. P., Broderick, G. A., Dmochowski, R. R., Heaton, J. P., Lue, T. F., 
Milbank, A. J., Nehra, A., & Sharlip, I. D. (2005). Erectile Dysfunction: Published 2005;
Reviewed and Validity confirmed 2011. American Urological Association. Retrieved
from: http://www.auanet.org/guidelines/erectile-dysfunction-(2005-reviewed-and-
validity-confirmed-2011
This article is the American Urological Association’s Clinical Guidelines for the management of Erectile Dysfunction. The entire document is 288 pages, but contains all the treatment options available, including medications, drug injection therapy, vacuum devices, surgical therapies, and others. This article is relevant because it is the standard for how Urologists are trained to treat ED. A comprehensive approach to ED includes examining the issues through a biopsychosocial model. Knowledge of the medical aspects of treating this disorder is invaluable in fully understanding the individual’s biological issues, which is part of the Intersystem Approach (Gambescia & Weeks, 2015).
Rew, K. T., & Heidelbaugh, J. J. (2016). Erectile Dysfunction. American Family Physician,
94(10), 820-827.
This article comes from the American Academy of Family Physicians. It provides information of ED’s definition, prevalence, assessment tools, causes, co-morbid conditions, aggravating factors, and current treatments. This article provides a lot of helpful information for both myself and even my clients (when appropriate) as it provides charts and tables that can be extracted and used for psychoeducational purposes. It also includes a decision tree on diagnosis and management as well as practical information on the differences between the most prescribed medications for ED. I can see myself using this article to reference if I am unsure of a medical issue that could be partly responsible. I strive to know as much as I can because I often find that clients seek my services before consulting with a physician. I use this article to identify issues that may necessitate a medical evaluation.
Kucuk, E. V., Tahra, A., Bindayi, A., & Onol, F. F. (2016). Erectile dysfunction patients are 
 more satisfied with penile prosthesis implantation compared with tadalafil and
intracavernosal injection treatments. Andrology, 4, 952-956.
This article peaked my interest because I have had a few clients with penile prosthetics and I do not know enough about this treatment method. This study investigated various treatments for ED and aimed to compare patient satisfaction. They used the IIEF and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) to gauge client satisfaction and improvement in ED symptoms. They found that ED patients who had a penile prosthesis implant were more satisfied when compared to tadalafil and injections. This result is surprising to me as I have only heard my clients struggle with implants, so I wish to know what may be changing in the field. Currently, oral medication is generally the first treatment option for ED while injections are sometimes considered if medication does not work. The third consideration for treatment is generally a prosthesis, so this article needs to be critically investigated and future research needs to see if this is true cross-culturally.
Silva, A. B., Sousa, N., Azevedo, L. F., & Martins, C. (2016). Physical activity and exercise for 
erectile dysfunction: Systematic review and meta-analysis. British Journal of Sports 
Medicine, 0, 1-7.
I chose this article because it is a systematic review of an area of interest for me in treating ED. They reviewed 7 studies which ranged between 8 weeks and 2 years in length, and pooled data indicated a statistically significant improvement in erectile function when engaged in an exercise intervention as part of ED treatment. The review suggests that physical activity may be an important intervention for my clients and I should include it as part of my initial recommendations.
Websites
https://www.healthline.com/health/erectile-dysfunction
This website includes medically reviewed information about the following aspects of erectile dysfunction: symptoms, causes, incidence, diagnosis, treatments, medications, natural remedies, talk therapy, alternative treatments, and outlook for the future. It is easily readable for clients and can be used as a handout or sent to clients as a link.
https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
The well-known and respected Mayo clinic is a recognizable and trusted source for medical information. My clients will be familiar with the clinic and potentially that will help them trust this source. This page includes information about ED in the following areas: symptoms, when to see a doctor, causes, risk factors, complications, and prevention.
https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction
This website is run by the Official Foundation of the American Urological Association, and provides easily accessible information on ED symptoms, causes, diagnosis, treatment, and after treatment considerations. What I like about this website is that it discusses how erections actually work, which may be new information for clients. I find that when clients understand the complexities of this system, they are less hard on themselves and reduce their self-blame and shame.
https://medlineplus.gov/erectiledysfunction.html
This website is run by the National Institute of Health U.S. National Library of Medicine, and provides readable information on ED. This website also includes information on research (clinical trials, journal articles), resources to find someone who can help, and patient handouts. It also includes videos and links to how certain medical concerns (cardiovascular disease, diabetes, and cancer). This website can be used by myself and clients for reference purposes. It has the added benefit of providing unique links to more specific issues not typically included on other websites (bent penis, how cancer affects sex life).
References
Abraham, L., Symonds, T., & Morris, M. F. (2008). Sexual Quality of Life−Male. Psyctests,
doi:10.1037/t62208-000
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental             Disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Cappelleri, J. C., Bushmakin, A. G., Zou, K. H., Carlsson, M. O., & Symonds, T. (2012).
Cumulative response curves to enhance interpretation of treatment differences on the
Self-Esteem and Relationship questionnaire for men with erectile dysfunction. BJU International111(3B), E115-E120.
Coyne, K., Mandalia, S., McCullough, S., Catalan, J., Noestlinger, C., Colebunders, R., &
Asboe, D. (2010). International Index of Erectile Function—Adapted Tool for Men Who
Have Sex with Men. Psyctests, doi:10.1037/t31863-000
Gambescia, N., & Weeks, G. R. (2015). Systemic treatment of erectile disorder. K. M. Hertlein, G. R. Weeks, & N. Gambescia (Eds.). Systemic sex therapy (2nd ed.). (pp. 72-89). New York, NY, US: Routledge/Taylor & Francis Group.
Heidelbaugh, J. J. (2010). Management of erectile dysfunction. American Family Physician, 
81(3), 305-312.
Kapoor, R., & Kapoor, A. (2016). Erectile dysfunction: A present day coronary disease risk
equivalent. Indian Journal of Medical Research, 144, 307-310.  
Kucuk, E. V., Tahra, A., Bindayi, A., & Onol, F. F. (2016). Erectile dysfunction patients are
more satisfied with penile prosthesis implantation compared with tadalafil and
intracavernosal injection treatments. Andrology, 4, 952-956.
Montague, D. K., Jarow, J. P., Broderick, G. A., Dmochowski, R. R., Heaton, J. P., Lue, T. F.,
Milbank, A. J., Nehra, A., & Sharlip, I. D. (2005). Erectile Dysfunction: Published 2005;
Reviewed and Validity confirmed 2011. American Urological Association. Retrieved
from: http://www.auanet.org/guidelines/erectile-dysfunction-(2005-reviewed-and-
validity-confirmed-2011
Rew, K. T., & Heidelbaugh, J. J. (2016). Erectile Dysfunction. American Family Physician
94(10), 820-827.
Rosen, R. C., Cappelleri, J. C., Smith, M. D., Lipsky, J., & Peña, B. M. (1999). International
Index of Erectile Function-5. Psyctests, doi:10.1037/t21667-000
Silva, A. B., Sousa, N., Azevedo, L. F., & Martins, C. (2016). Physical activity and exercise for
erectile dysfunction: Systematic review and meta-analysis. British Journal of Sports 
Medicine, 0, 1-7.

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