Association of Sexual Health and Mental Health in Erectile Dysfunction: Expert Opinion From the Indian Context

Abstract

Erectile dysfunction (ED) is a common condition in men, driven by a complex interplay of organic, relational, and psychological factors, necessitating an integrated treatment approach. Psychological factors, such as anxiety, depression, and stress, are significant contributors to erectile problems. Erectile dysfunction can have severe psychological consequences, including feelings of emasculation, humiliation, reduced self-confidence, isolation, loneliness, and a decline in overall well-being. A national advisory board comprising 12 experts from India, including 9 urologists and 3 psychiatrists, convened to discuss a multidisciplinary approach to the treatment of ED. Using a modified Delphi method and literature review, the 34 panels developed evidence-based insights. Experts highlighted the importance of thorough assessments of sexual dysfunction in patients. Given the frequent comorbidity of mental health issues with ED, physicians should proactively explore patients' sexual and mental health. Creating a secure and welcoming environment is crucial for these assessments. Physicians should gather detailed information on psychological symptoms, stressors, relationship dynamics, cognitive style, and distractions. Experts highlighted the importance of thorough diagnostic assessments and recommended a multidisciplinary approach integrating pharmacological interventions (e.g., phosphodiesterase-5 inhibitors) with psychometric therapy, tailored to the age, existing comorbidities, and underlying causes of ED. A balanced, interdisciplinary approach incorporating psychosexual therapy, lifestyle modifications, and advanced therapies is crucial for the holistic management of ED. Key consensus recommendations also emphasized fostering open communication between patients and healthcare providers, routine mental health screenings in patients with ED, and early referrals to specialists when necessary. Clinicians should actively involve mental health professionals in the management of ED and prioritize individualized treatment strategies tailored to each patient's needs. This multifactorial condition requires coordinated efforts to address both organic and psychogenic causes, restore patients' quality of life, and promote open communication. By proactively engaging with patients, addressing their concerns, and facilitating referrals as needed, clinicians can significantly improve outcomes for patients with ED.

Keywords: anxiety; depression; diabetes mellitus-induced erectile dysfunction; endothelial dysfunction; erectile dysfunction; mental health; phosphodiesterase-5 inhibitors; psychosexual therapy.

Figure 1. Probable global increase in the prevalence of erectile dysfunction from 1995 to 2005

ED: erectile dysfunction Based on data from: [2]

Figure 2. Factors contributing to erectile dysfunction

Based on data from: [6]

Figure 3. Comprehensive diagnostic pathway for erectile dysfunction

ED: erectile dysfunction; HbA1c: glycated hemoglobin; IIEF: International Index of Erectile Function Based on the author’s personal experiences

Figure 4. Multidisciplinary approach for the management of erectile dysfunction

*Psychosexual counseling: address emotional and psychological factors; †Drug therapy: utilize medications to enhance erectile function; ††Acoustic shock wave: enhance vascularization and improve blood flow in the penis; ¶Lifestyle changes: promote healthy habits and physical activity; §Vacuum erection device: use vacuum devices to mechanically induce erections PDE5: phosphodiesterase type 5 Based on data from: [48]