Weaning and Relapse Prevention

In general, the concept of relapse prevention has not been incorporated into sexual medicine. Yet SD is recognized as a progressive disease in terms of underlying organic pathology, which may play a role in altering threshold for response and potential re-emergence of dysfunction. Both McCarthy and Perelman have recommended that the clinician schedule "booster" or follow-up sessions in order to help the patient stay the course and provide opportunity for additional treatment when necessary (20,48). These concepts are derivative of an "addiction" treatment model where intermittent, but continuous care is the treatment of choice. Additionally, utilizing sex therapy concepts in combination with sexual pharmaceuticals offers potential for minimizing dose and temporary or permanent weaning from medication depending on the severity of organic and psychosocial factors. SDs are frequently progressive diseases, but this is especially true for ED. Over time the progressive exacerbation of either organic factors (endothelial disease, etc.) or PSOs may adversely impact a previously successful treatment regimen. Furthermore, although there is no current evidence for tachyphylaxis, neither are there extensive studies beyond 10 years indicating long-term efficacy of PDE-5s. No doubt, escalating dose and providing alternative medications would be most physician's initial response of choice. However, both these processes may be modulated and mediated by sexual counseling and education. Sex therapy and other cognitive-behavioral techniques and strategies could be extremely important in facilitating long-term medication maintenance, and helping to ensure continuing medication success. As such, clinicians caring for ED patients, are well advised to incorporate these counseling techniques into the treatment they provide themselves, or through referral. Each case requires individual consideration in part determined by patient preference regarding level of outcome success desired. Levine (16) presented an interesting discussion on multiple dimensions of treatment success.

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