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Cognitive Changes Predict Continued Recovery of Erectile Functioning Versus Relapse After Discontinuation of Sildenafil Treatment for Male Erectile Dysfunction

From the Department of Medical, Clinical, and Experimental Psychology (J.J.D.M.VL., M.A.VDH.) and the Department of General Practice (M.G.S.), University Maastricht, Maastricht, The Netherlands; and the Department of Medical, Clinical, and Experimental Psychology (J.J.D.M.VL) and the Department of Urology (G.A.VK.), Academic Hospital Maastricht, Maastricht, The Netherlands.

Address reprint requests to: Jacques van Lankveld, PhD, Department of Medical, Clinical and Experimental Psychology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: jvla{at}groupwise.azm.nl

Received for publication May 10, 2002; revision received September 12, 2002.

OBJECTIVE: To examine whether erectile functioning after termination of sildenafil intake in men with psychogenic ED (erectile dysfunction) can be predicted with psychological measures.

METHOD: The subjects in a nonrandomized controlled trial were 65 heterosexual men with acquired psychogenic ED, aged 54.2 ± 11 years. Sildenafil medication was taken as required before sexual activity, up to two times per week. Response to a global end point question ("Did the treatment you took during the study improve your physical response during sexual activity in the last 4 weeks?") was recorded after 6 weeks of sildenafil use and, subsequently, 6 weeks without medication. Other measures of sexual functioning and cognitive predictor measures were also administered.

RESULTS: Of the 65 participants who commenced sildenafil treatment, 37% withdrew from the study before follow-up assessment. At posttreatment, 89% of participants reported that treatment had improved or cured their erectile functioning. At follow-up, 66% of participants had maintained posttreatment gains. Response at follow-up could be predicted (p < .001) with 96% sensitivity and 50% specificity by entering changes in sexual self-confidence and the participant’s rating of his partner’s wish to continue treatment in a logistic regression model. Higher odds for recovery of erectile functioning were found in participants reporting increased sexual self-confidence and the estimation that their partner wanted them to continue sildenafil use. High pretreatment sexual desire was found to further increase the odds for positive responding at follow-up.

CONCLUSIONS: The present results indicate that continued improvement of erectile functioning is possible after discontinuation of sildenafil use in men with psychogenic ED. Maintenance of gains can be predicted from cognitive changes before medication is withdrawn.

Key Words: erectile dysfunction, • sildenafil, • cognition.

Abbreviations: ED = erectile dysfunction;; EDITS = Erectile Dysfunction Inventory of Treatment Satisfaction;; EDITS-P= Erectile Dysfunction Inventory of Treatment Satisfaction, Partner Version;; GRISS = Golombok Rust Inventory of Sexual Satisfaction;; IIEF = International Index of Erectile Function;; MANOVA = multivariate analysis of variance;; VAS = visual analog scales.