Psychological treatments for erectile dysfunction

Psychological treatments for erectile dysfunction

By Dr John Barry

About a third of men experience difficulty in getting or maintaining an erection, and this percentage increases in older men. Around 85% of men find that sildenifal (Viagra) improves their erections. This is a good success rate, but it doesn’t address any underlying psychological issues the man might have in relation to sex or relationships. In fact the success of Viagra has led researchers to focus almost entirely on organic factors in erectile dysfunction (ED) rather than psychological factors.

Research shows about 40% of cases of ED are caused by psychological (psychogenic) factors alone, though psychological and physiological (organic) causes can interact. If you can achieve an erection through masturbation but not with a partner, then the cause is probably psychogenic. If you can’t achieve an erection at all, the cause is probably organic.

The main causes of psychogenic ED are depressed mood, low self-esteem, anxiety, and stress. The causes can be grouped into three categories: performance anxiety, recent stressful life events, and vulnerabilities from childhood and adolescence.

The main organic causes of ED are: cardiovascular disease (blood pressure, cholesterol), diabetes, surgery to prostate (prostatectomy), loss of T (e.g. due to ADT androgen deprivation therapy in prostate Ca), drug & alcohol intoxication or side effects.

We know that Viagra has a good success rate, but how well does ED respond to psychological therapies? Well, hypnotherapy has been found to be successful in 70% of cases of ED. A meta-analysis of 11 randomised controlled trails (RCTs) of 398 men found that group therapy improves ED compared to no-treatment, and combining Viagra with group treatment caused a significant improvement in ED compared to those who received Viagra alone. Psychological interventions also compared well to local injection and vacuum devices for ED. The success of group interventions echos evidence that group therapy and educational (information-sharing) interventions a sometimes more successful in ED than more traditional one-to-one psychological approaches, and this would be in line with other research on gender differences in preferences for therapy.

So what should you do if you experience ED? First of all, try not to worry about it because effective therapies are available, and worry can become a vicious cycle. Try to establish the cause by asking yourself questions such as: can you achieve and erection by yourself but not with a partner? Do you have an undiagnosed medical condition such as heart disease or diabetes? Are you under a lot of stress at work? If in any doubt visit your GP. And remember that although most men don’t exactly brag about it, ED is a pretty common condition, and one that can be successfully treated.

 

About the author

Dr John Barry is a Chartered Psychologist and co-founder of the Male Psychology Network and Male Psychology Section of the British Psychological Society. He is one of the editors of, and contributors to, The Palgrave Handbook of Male Psychology and Mental Health

 

The Palgrave Handbook of Male Psychology and Mental Health will be released in April 2019.

From the back cover:

“This handbook brings together experts from across the world to discuss men’s mental health, from prenatal development, through childhood, adolescence, and fatherhood. Men and masculinity are explored from multiple perspectives including evolutionary, cross-cultural, cognitive, biological, developmental, and existential viewpoints, with a focus on practical suggestions and demonstrations of successful clinical work with men”.

 

 

 

 

Polycystic ovary syndrome (PCOS) and stress at Christmas time

Polycystic ovary syndrome (PCOS) and stress at Christmas time

Depression is relatively common in PCOS. Christmas can often feel like a time when we should be happy, so any sources of unhappiness – such as the troubling symptoms of PCOS – can seem especially hurtful at this time of year.

I hope everyone has a fantastic Christmas, but you don’t have to be a psychologist to realise that this time of year can have stressful for people with medical conditions, or other stressful things to deal with. For women with PCOS, some typical Christmas stressors are:

Overeating

Most people overeat at Christmas. However, women with PCOS – many of whom already are overweight – might experience feelings of guilt due to overeating.

Even for healthy people, just a single day of binging on high-fat foods is enough to impair glycaemic control and reduce insulin sensitivity (Parry et al, 2017). This obviously has important implications for women with PCOS, many of whom are prone to developing insulin resistance and type 2 diabetes.

Women with PCOS also are prone to hypoglycaemia (low blood sugar levels), which is made worse by feasting on the type of high sugar / high carb foods that we see at Christmas. Low blood sugar can cause low mood (Barry et al, 2011), so for women with PCOS, the foods that usually make us happy at this time of year can, paradoxically, make us sad. (For the new year, women with PCOS could consider trying Marsh et al’s low-GI diet).

Fertility issues

PCOS can have an impact on fertility, and reduce the ability to have children. It is often said that Christmas is a time for families and especially children, so women with PCOS might feel the additional strain of fertility problems over Christmas.

How can hypnotherapy help?

Hypnotherapy can help with both the emotional, behavioural, and even some of the biochemical aspects of PCOS (Barry et al, 2017). Christmas is a time for miracles, and while hypnotherapy does not offer a miracle cure, it certainly offers the chance of improvement for many women with PCOS.

 

References

Barry JA, Bouloux P, Hardiman, PJ (2011). The impact of eating behavior on psychological symptoms typical of reactive hypoglycemia: a pilot study comparing women with polycystic ovary syndrome to controls. Appetite, 57, 73-76

Barry, J. A., Leite, N., Sivarajah, N., Keevil, B., Owen, L., Miranda, L. C., … & Hardiman, P. (2017). Relaxation and guided imagery significantly reduces androgen levels and distress in Polycystic Ovary Syndrome: Pilot study. Contemporary Hypnosis and Integrative Therapy, 32(1), 21-29.

Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010). Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome–. The American journal of clinical nutrition, 92(1), 83-92.

Parry S, Woods R, Hodson L, Hulston C. A single day of excessive dietary fat intake reduces whole-body insulin sensitivity: The metabolic consequence of binge eating. Nutrients. 2017;9(8):818.

 

 

 

 

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