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Assessing the effectiveness of different approaches to psychotherapy in the context of complex treatment of sexual disorders

Introduction

Sexual failure is one of the most powerful emotional traumas for men of any age. Sexual dysfunction in men, including erectile dysfunction, limits their reproductive capabilities, prevents the achievement of marital and sexual harmony in a couple, disrupts the stability of marriage, negatively affects mental balance and performance, leads to the development of neurotic and depressive disorders, alcohol abuse and antisocial behavior, also increasing suicidal tendencies. It is noted that mental illnesses are often accompanied by sexual dysfunctions. In most cases, they are diagnosed for the first time at an appointment with a sexologist due to complaints of erectile dysfunction.
In this regard, research examining the relationship between sexual and mental disorders is of great relevance, including those studies that focus on assessing the effectiveness of various approaches to psychotherapy in the context of comprehensive treatment of sexual disorders in men with diagnosed mental disorders.
To date, the largest number of studies have been devoted to sexual dysfunction in men with neurotic conditions. Even in cases where sexual disorders are not dominant among other clinical manifestations of mental disorders and neurotic conditions, the disharmony of sexual life that arises as a result of these disorders in itself acts as a traumatic experience, which greatly complicates the clinical picture. In light of this, it is critical to evaluate the effectiveness of different psychotherapy approaches in the context of comprehensive treatment of sexual disorders.
In general, we can confidently state that there is a very clear relationship between the structure of mental sexual pathology in sexual dysfunctions in men with mental disorders of a non-psychotic level (Exploring the psychological mechanisms underlying the relationship between depression and anxiety and sexual health). Personal, constitutional, somatic, age-related and social factors take part in the formation of disturbances in the manifestations of sexual activity and the nature of mental disorders during sexual dysfunctions in patients with mental disorders of a non-psychotic level.

Psychotherapy in the complex treatment of erectile dysfunction

Advances in fundamental medicine at the end of the 20th century, along with large-scale clinical studies based on the latest advances in pharmacology, made it possible to apply new approaches to the treatment of erectile disorders. The appearance of the first drugs for oral use, which helped strengthen erections, was accompanied by a certain “euphoria”, which foreshadowed the final solution to problems with erectile dysfunction and relegated psychotherapeutic techniques to the background. The discovery of a new pharmacological group of drugs – phosphodiesterase type 5 inhibitors (PDE-5: Viagra, Cialis, Levitra) – marked the beginning of a new era of drug treatment of erectile disorders. Due to their availability, these drugs were prescribed to patients not only by specialists (urologists and sexologists), but also by therapists.
However, now that the boom in the use of PDE5 inhibitors has subsided, it has become clear that the problem of erectile dysfunction cannot be solved solely through drugs that affect blood flow in the male genital organs. In this regard, in order to optimize the treatment of sexual disorders in men with mental disorders, research is needed to specifically study the effectiveness of various methods of psychotherapy and pharmacotherapy for erectile disorders, both individually and in combination with a comparison of therapeutic dynamics to develop criteria for differentiated therapy taking into account personal characteristics , family-partner situation, duration of sexual disorder and psychological status of patients.
Almost all patients with sexual dysfunctions need psychotherapeutic help, since even in the absence of obvious neurotic symptoms, they experience mental discomfort and understandable psychological fears due to a decrease in the manifestations of their sexual activity. Today there is no one method of psychotherapy that would equally effectively affect the entire range of psychological problems of men suffering from erectile dysfunction and mental disorders. Nevertheless, such psychotherapeutic directions as Ericksonian hypnotherapy, short-term multimodal psychotherapy, neurolinguistic programming, family and marital therapy, desensitization and others are becoming quite widespread. A number of sexologists use a combined psychotherapeutic approach, including elements of psychoanalysis and behavioral therapy. Their basic principles and range of therapeutic effects are in good agreement with the objectives of psychotherapy for sexological patients.

Conclusion

The effectiveness of treatment for erectile dysfunction in men with diagnosed mental disorders increases if it includes not only the use of phosphoesterase type 5 inhibitors, but also psychotherapy, and especially cognitive behavioral psychotherapy (Types of Psychotherapy).
Men suffering from psychogenic erectile dysfunction develop neurotic disorders as a reaction to a stress factor in the intimate and personal sphere, which aggravates sexual dysfunction. Improved erection, reduction of psychopathological symptoms and restoration of sexual life are observed with all treatment options, while the preservation of the positive effect depends on personal characteristics, the nature of the partner situation and the duration of the sexual disorder.
In the treatment of patients with psychogenic erectile disorders in the presence of anxious-suspicious and asthenic or depressive personality traits, conflictual partnerships or in the absence of a permanent partner, only the use of psychotherapeutic measures allows achieving sustainable results. At the same time, in the presence of asthenic personality traits and anxiety, compensated by long-term partnerships and a short duration of sexual dysfunction, it is possible to limit the treatment of erectile dysfunction to the use of only one of the phosphodiesterase type 5 inhibitors, which allows you to restore sexual function in the shortest possible time.

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