The therapeutic dilemma: how to use psychotherapy

Organic, marital and intrapsychic disturbances mutually interact in the pathogenesis of erectile dysfunction (ED). Sexual psychotherapy (SP) should be considered a useful chance on all occasions. When non-organic causes are predominant, SP could help in solving the problem. Conversely, when ED is mainly a symptom of organic diseases, SP should be considered as an important support, reducing the net contribution of marital and/or intrapsychic components and improving responsiveness and compliance to medical treatments. A correct diagnosis is a crucial step in the evaluation of patients reporting ED, in order to quantify the contribution of different pathogenetic factors. Structured Interview on Erectile Dysfunction (SIEDY) is a useful instrument for the first screening of ED patients, providing scores for organic, marital and intrapsychic components. Other instruments, such as body paint or sexuality tree, might also be used to further analyse the problem and to choose the most effective SP intervention for the patient himself or for the couple. In our view, medical and psychosexual therapies are not indeed two distinct therapeutic entities to be used in different clinical settings, but are two important tools to be simultaneously considered (and often simultaneously employed) to fully rescue the sexual satisfaction of the couple.