Rosen Raymond, Janssen Erick, Wiegel Markus, Bancroft John, Althof Stanley, Wincze John, Segraves R Taylor, Barlow David
Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey 088454, USA.
J Sex Marital Ther. 2006 May-Jun;32(3):215-34. doi: 10.1080/00926230600575314.
The role of psychological and interpersonal factors in the treatment of erectile dysfunction (ED) with sildenafil or other oral therapies has not been sufficiently investigated. We conducted a pilot study of psychosocial predictors of pharmacotherapy treatment outcome and satisfaction in men with ED and their partners. Sixty-nine men with mild to moderate ED and their partners were enrolled in a multicenter, open-label, treatment trial with sildenafil. Treatment measures included a battery of validated self-report measures and questionnaires. Subjects also were interviewed according to a semistructured interview protocol. Partner assessments included self-report measures of sexual function, mood, and relationship satisfaction. Results indicated that, prior to treatment, patients had erectile function scores in the range of mild to moderate ED, with relatively low levels of concomitant depression, anxiety, and psychological stress and high overall levels of relationship adjustment. Partner sexual function was in the normal range of total Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, Leiblum, 1994) scores, although more than one third of female partners had specific sexual complaints or problems. Among couples who completed one or both follow-up visits (N = 34), sildenafil treatment resulted in significant improvements in all aspects of sexual function in men, including sexual desire, orgasmic function, erectile function and overall sexual satisfaction. Significant improvements also were noted in partners' ratings of sexual function in most domains, including arousal, pleasure, and orgasm. Higher baseline levels of sex-specific anxiety were negatively associated with improvement in erections following treatment. Relationship adjustment at baseline, contrary to expectations, did not predict erectile or sexual satisfaction following treatment in the men or their partners but was significantly correlated with changes in sexual desire. Baseline levels of depression, anxiety, and stress generally were unrelated to efficacy or treatment satisfaction. However, we observed a curvilinear relationship in the men between baseline levels of stress and treatment discontinuation (i.e., subjects with moderate levels of stress were less likely to discontinue treatment). Because of a high number of dropouts, results of this pilot study await confirmation in a larger and more adequately powered clinical trial.
心理和人际因素在使用西地那非或其他口服疗法治疗勃起功能障碍（ED）中的作用尚未得到充分研究。我们针对ED男性患者及其伴侣开展了一项关于药物治疗效果和满意度的心理社会预测因素的初步研究。69名轻度至中度ED男性患者及其伴侣参与了一项使用西地那非的多中心、开放标签治疗试验。治疗措施包括一系列经过验证的自我报告测量方法和问卷。受试者还根据半结构化访谈协议接受访谈。伴侣评估包括性功能、情绪和关系满意度的自我报告测量方法。结果表明，治疗前，患者的勃起功能评分处于轻度至中度ED范围内，伴有抑郁、焦虑和心理压力的水平相对较低，关系调适的总体水平较高。伴侣的性功能处于女性性功能简要指数（BISF-W；泰勒、罗森、莱布卢姆，1994年）总分的正常范围内，尽管超过三分之一的女性伴侣有特定的性抱怨或问题。在完成一次或两次随访的夫妇中（N = 34），西地那非治疗使男性性功能的各个方面都有显著改善，包括性欲、性高潮功能、勃起功能和总体性满意度。在大多数领域，伴侣对性功能的评分也有显著改善，包括性唤起、性快感和性高潮。特定性别的基线焦虑水平较高与治疗后勃起功能的改善呈负相关。与预期相反，基线时的关系调适并不能预测男性患者及其伴侣治疗后的勃起或性满意度，但与性欲变化显著相关。抑郁、焦虑和压力的基线水平通常与疗效或治疗满意度无关。然而，我们观察到男性患者基线压力水平与治疗中断之间存在曲线关系（即压力水平中等的受试者更不太可能中断治疗）。由于大量受试者退出，这项初步研究的结果有待在规模更大、效力更充足的临床试验中得到证实。
