The Psychiatric, Psychological, and Psychotherapeutic Approach to Erectile Dysfunction – Between Good Practices and Clinical Challenges
Authors:   Department of Psychiatry, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Vasiliu Octavian , Mangalagiu Andrei G. ,   Department of Psychiatry, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Petrescu Bogdan M. ,   Department of Psychiatry, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Cândea Cristian A. ,   Department of Psychiatry, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Pleșa Cristina F. ,   Department of Neurology, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania
“Dr. Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Ungureanu Daniela ,   Department of Psychiatry, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Dobre Monica ,   Department of Psychiatry, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Vasiliu Diana G. ,   Regina Maria Social Foundation, Bucharest, Romania, Năstase Cristian ,   Department of Neurosurgery, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania, Sirbu Carmen A. ,   Department of Neurology, “Dr. Carol Davila” University Central Emergency Military Hospital, Bucharest, Romania “Dr. Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Published: January 2024

Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the
shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual’s sexual life but may also
contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process
and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach
is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes,
and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or
inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric,
psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The
results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales,
questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED
support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual
therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a
combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the
treatment to the patient’s particularities.