Treatment is a dynamic process requiring ongoing re-assessment. The previously described “sex status” is used and regularly re-applied during the treatment process. As the degree of treatment intrusiveness increases, there must be a continuing awareness of the intra- and interpersonal forces that interfere with, or enhance, medical and or surgical outcome. It is the essence of sexual coaching to optimize pharmaceutical efficacy.
Rosen summarized the following approaches used by sex therapists: (a) anxiety reduction and desensitization; (b) cognitive-behavioral interventions; (c) increased sexual stimulation; and (d) interpersonal assertiveness and couples’ communication train-ing. Regardless of etiology, most physicians initiate treatment with a PDE-5, even if the ED is primarily psychogenic in origin. This partly results from the extremely high PDE-5 efficacy rate with psychogenic ED.
There are three highly efficacious PDE-5 inhib-itors that have been approved by the Food and Drug Administration as treatments for ED: sildenafil, vardenafil, and tadalafil, all of which are used worldwide. Simple cases respond well to these agents when proper advice on pill use, expectation management, and a cooperative sex partner are provided. Clinicians should provide choice and unbiased, fair-balanced description of treatment options, including pharmacokinetic properties, efficacy studies, and the clinician’s patients’ experiences. Consequently, the patient will attribute greater importance to the clinician’s opinion.
Clinicians who provide these important guidelines that incorporate patient preference will experience enhanced healer– patient relationships, minimized PSOs, and improved compliance. Patient preferences may reflect key marketing messages of the respective pharmaceutical companies. Clini-cians can take advantage of this hypothesis to increase efficacy. If safety and long-term side effects are a primary concern, sildenafil has the oldest/longest database. In vitro selectivity may or may not translate to clinical reality, but some patients believe vardena-fil provides the best quality erection with the fewest side effects. Clearly provides the longest duration of action.
The sexual status interview can create awareness of the patient’s sexual script and expectations, leading to improved recommendations and management. Here, sexual script refers to style and process of an individual’s or couple’s premorbid sex life. A clinician can improve outcome by clarifying whether a patient would perform better by practicing with masturbation or by re-introducing sex with a partner. The first time a recently divorced man (who is using condoms for the first time in years) tries a sexual pharmaceutical, he will probably perform better if he first masturbates while wearing a condom, than if he attempts partnered sex with viagra online Canadian Pharmacy.
Comprehending pharmacokinetics (onset, duration of action, etc.) plus sexual script analysis can optimize treatment by improving the correct prescription selection proba-bility. Pharmaceutical selection can be fine-tuned by understanding the couple’s “sexual script,” leading to better orgasm and sexual satisfaction. Dosing instructions should focus on returning to previously successful sexual scripts, as if medication was not even necessary. Thus, the patient is likely to receive adequate stimulation, and the treatment will be perceived as partner-sensitive. Recommendations for sexual recovery are improved by
awareness of individual differences. Differences in sexual style (sex script analysis) can determine which medication can be effectively used by a couple, with less change required in their “normal” sexual interactions. Matching the right medication to the individual/ couple based on pharmacokinetics and sexual script increases efficacy, satisfaction, com-pliance, and improved continuation rates. Rather than changing the couple’s sexual style to fit the treatment, a physician should try to fit the treatment to the couple.