Abstract
In view of high drop-out rates from auto-injection therapy for impotence, a treatment strategy was established that combined psychosexual therapy with intracavernous self-injections. Sixty-eight men (mean age: 52 years, s = 11, 7) were included into an integrated psycho-somatic evaluation and treatment program. The comprehensive psychological evaluation consisted of a self-developed, multidimensional questionnaire and a thorough clinical interview. In 52% of the cases the partner could be included in the evaluation process. The somatic evaluation consisted of the oscillometric (DINAMAP® 1846SX) assessment of the penisbrachialis index, doppler study of penile arteries (both before and after intracavernous injection), and the intracavernous injection of a vasoactive substance (papaverine, papaverine/phentolamine, if required). The etiology was rated as somatogenic in 13%, as mixed in 31%, and as psychogenic in 56% of cases. All patients were offered a trial of sexual therapy. In addition, 46% were instructed in self-injection therapy. The patients who accepted and employed auto-injection therapy were older, rated their sexual pleasure and satisfaction significantly higher, had no diminished or lost sexual desire, reported less partner problems but complained of a lack of desire in their partners. In a 1-year follow-up 37% of our sample were classified as not improved, 19% as slightly improved, and 44% as improved. The predictors of outcome were determined by means of discriminant and logistic regression analyses. The results show that the following variables significantly contribute to the outcome of the the combined treatment program: partner problems (negative predictor), premature ejaculation (negative predictor), predominantly organogenic impotence (positive predictor), employment of auto-injection therapy (positive predictor), reduction of sexual desire (negative predictor), adequate sexual stimulation by partner (positive predictor), and smoking (negative predictor). The results of our study indicate that a combination of psychosexual and self-injection therapies can be a promising therapeutic option. Patients with psychogenic impotence, however, can only benefit from this integrative therapy if they have no serious partner problems and no premature ejaculation.