A Cochrane review [Abstract] 1 included 11 studies with a total of 398 subjects. Diagnosis were stated as primary erectile dysfunction (ED) (n = 2) and secondary ED (n = 9). The most common range of age inclusion was 18 years and older, with ED of at least 3 to 6 months duration. Exclusion criteria applied in most trials included genital anatomic deformity, primary nonerectile sexual disorder, hyperprolactinaemia, hypogonadism, major psychiatric disorders, and alcohol or substance abuse.
In data pooled from five randomised trials, group psychotherapy was more likely than waiting list to reduce the number of men with "persistence of ED" at post-treatment (RR 0.40, 95% CI 0.17 to 0.98, N = 100; NNT 1.61, 95% CI 0.97 to 4.76) and at six months (RR 0.43, 95% CI 0.26 to 0.72, N = 37; NNT 1.58, 95% CI 1.17 to 2.43). In data pooled from two randomised trials sex-group psychotherapy reduced the number of men with "persistence of ED" in post-treatment (RR 0.13, 95% CI 0.04 to 0.43, N = 37), with a 95% response rate for sex therapy and 0% for the control group (waiting list) (NNT 1.07, 95% CI 0.86 to 1.44). In two trials that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant reduction of "persistence of ED" (RR 0.46, 95% CI 0.24 to 0.88; NNT 3.57, 95% CI 2 to 16.7, N = 71), and were less likely than those receiving only sildenafil to drop out (RR 0.29, 95% CI 0.09 to 0.93). One small trial directly comparing group therapy and sildenafil citrate found a significant difference favouring group therapy in the mean difference of the International Index of Erectile Function (IIEF) (WMD -12.40, 95% CI -20.81 to -3.99, N = 20). No differences in effectiveness were found between psychosocial interventions versus local injection and vacuum devices.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by indirectness (differences in studied patients).
Primary/Secondary Keywords