Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility.

Abstract

Conventional management of erectile dysfunction (ED)-related non-consummation and infertility often overlooks psychosocial determinants and dyadic involvement, leading to suboptimal therapeutic outcomes, including persistent sexual dysfunction and reduced couple satisfaction. This study proposes and validates a novel, patient-centric intervention tailored for young individuals with psychogenic ED (pED), targeting both erectile recovery and infertility resolution. The "Streamlined Clinical Process" incorporates structured treatment strategies for both the patient and their partner, including evidence-based sexual health education, psychological support, partner-inclusive counseling, sensate focus training, lifestyle modification, on-demand pharmacotherapy, and structured follow-up. Following comprehensive baseline assessments (medical history, physical examination, and diagnostics), the treatment team collaboratively formulates individualized 16-week regimens with active partner engagement. Three key innovations distinguish this protocol: (1) The implementation of the GLTC (Goodwill-Listening-Talking-Cooperation) communication framework, which addresses patients' psychological needs and promotes effective communication strategies; (2) The application of Hawton's psychosexual stratification to identify specific psychological factors, with the aim of reshaping negative sexual beliefs, alleviating anxiety, improving sexual function, and rebuilding mutual trust and emotional connection between partners; (3) The development of easy-to-understand videos for psychological education to enhance treatment adherence through iterative patient-provider dialogue. Results demonstrate clinically meaningful improvements in erectile function recovery rates, coital success frequency, and couple satisfaction. Notable challenges include patient adherence to the treatment plan and the timely effectiveness of non-pharmacological interventions. In conclusion, this model presents a scalable and effective strategy for addressing sexual dysfunction-related infertility in young patients, offering a valuable framework for clinical practice and future research in sexual medicine.