***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We provide current , normative data on the prevalence of impotence , and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study . The Massachusetts Male Aging Study was a community based , r and om sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston , Massachusetts .  Blood sample s , physiological measures , socio-demographic variables , psychological indexes , and information on health status , medications , smoking and lifestyle were collected by trained interviewers in the subject 's home . A self-administered sexual activity question  naire was used to characterize erectile potency . The combined prevalence of minimal , moderate and complete impotence was 52 % . The prevalence of complete impotence tripled from 5 to 15 % between subject ages 40 and 70 years . Subject age was the variable most strongly associated with impotence . After adjustment for age , a higher probability of impotence was directly correlated with heart disease , hypertension , diabetes , associated medications , and indexes of anger and depression , and inversely correlated with serum dehydroepi and rosterone , high density lipoprotein cholesterol and an index of dominant personality . Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension . We conclude that impotence is a major health concern in light of the high prevalence , is strongly associated with age , has multiple determinants , including some risk factors for vascular disease , and may be due partly to modifiable para-aging phenomena We investigated the effect of adding a psychoeducational intervention to oral sildenafil ( PsychoedPlusMed ) in the treatment of  erectile dysfunction ( ED ) . Overall treatment satisfaction , as measured by the Erectile Dysfunction Inventory of Treatment Satisfaction ( EDITS ; Althof & Seftel , 1995 ) , was significantly higher in the PsychoedPlusMed  patients than in the sildenafil-only patients at 12 weeks and at 24 weeks . PsychoedPlusMed participants reported higher satisfaction with treatment onset , treatment duration , and sexual confidence .  PsychoePlusMed participants also reported an increase in communication about sex with their partner . A brief psychoeducational intervention can improve treatment satisfaction with sildenafil therapy for ED This study compared the effectiveness of two components , a ban on sexual intercourse and communication of sexual preferences , in the treatment of couples in which the male was experiencing erectile dysfunction . Sixteen couples were r and omly assigned to one of two treatment conditions . In one condition spouses were asked to refrain from intercourse and to make an effort to communicate sexual tastes and preferences during noncoital erotic interaction . Couples in the second condition were assigned only the communication portion of the therapeutic instructions given to the first group . The treatment consisted of written instructions concerning tasks to be carried out at home . Therapist contact was minimal . Following a 1-month baseline period of self-monitoring using a daily record-keeping form , couples underwent a 1-month treatment period and follow-up testing after another month . Male subjects also underwent an endocrinological examination to ascertain testosterone and related hormone levels prior to participating in the treatment . Both treatment groups reported significant improvement in several measures of erectile functioning , general sexual functioning , and marital adjustment . However , the ban on intercourse did not add to the effectiveness of encouraging sexual communication , indicating that the former component probably did not contribute to change . Two pretreatment measures , the Sexual Interaction Inventory and testosterone level , were found to predict treatment outcome with sufficient accuracy to permit selection of future patients who might benefit from this type of treatment format . The effectiveness of a treatment consisting of written instructions with minimal therapist contact for males with erectile dysfunction have important cost-benefit implication The treatment for psychogenic erectile dysfunction has been previously managed by non-medical methods consisting of counseling with a psychiatrist , psychologist or sex therapist . The success rate for treatment with counseling has not been uniformly successful . This paper compares the treatment of psychogenic erectile dysfunction using st and ard sex therapy and self-injection therapy using low-dose PGE1 .  Fifty men with psychogenic impotence were divided into two groups : st and ard sex therapy for twelve weeks or treatment using low-dose ( 2.5–5.0 μg ) of PGE1 . The results showed that men treated with low-dose PGE1 had a 47 % improvement of obtaining an unaided erection compared to 58 % improvement rate with sex therapy . 69 % of patients in the PGE1 group were satisfied with their treatment compared to 75 % receiving sex therapy .  The frequency of intercourse reported in patient diaries for the two groups was similar ( 20.5 per month for PGE1 vs 20.0 per month for sex therapy . The reported duration of erection by patients receiving PGE1 therapy was longer than that reported by those receiving sex therapy ( 35 min vs 10 min ) . The comparison of the cost of treatment of the two treatment groups reveals that the sex therapy is approximately 25 % more expensive than the PGE1 treatment . This pilot study demonstrates that the efficacy of PGE1 was numerically , though not statistically , less than sex therapy in the treatment of psychogenic impotence . The cost per positive outcome with PGE1 treatment is lower than that of sex therapy treatment making PGE1 more cost-effective Abstract In a prospect i ve investigation of the long-term outcome of 140 couples who had entered sex therapy 1–6 yrs earlier for a variety of sexual dysfunctions , successful follow-up , mostly by interview , was possible with at least one partner in 75 % of cases . While recurrence of sexual difficulties was common , coping strategies were identified which often helped overcome relapses . Improvements in couples ' general relationships result ing from treatment were usually sustained . Long-term outcome was excellent for vaginismus , good for erectile dysfunction , but often poor for premature ejaculation , and especially , for female impaired sexual interest . While the results of this study support the continued use of sex therapy for sexual dysfunction , they also emphasize the need for new therapeutic approaches for problems with poor outcome , especially female loss of sexual interest The effects of three group treatment formats on 20 men with secondary erectile dysfunction and their partners were contrasted . After a comprehensive medical and psychological screening , each couple was assigned to one of three treatment groups ( Communication Technique Training , Sexual Technique Training , Combination Treatment ) or to one of two control groups ( Attention-Placebo , No-Treatment ) . Couples in the three treatment groups and the attention-placebo group participated in their respective formats in twice-weekly sessions for a total of 20 hours . The no-treatment control group received sex education and treatment after a 5-week waiting list period . All three treatment groups fostered substantial gains so that between-format differences were not statistically significant . Subject variables which predicted success/experience ratio gains included age of the male partner , perceived level of relationship adjustment , and the male partner 's success/experience ratio prior to treatment . Eighty-one percent of the treated men reached the criterion of 80 % or greater success/experience ratio ( successful penetration and subsequent ejaculation ) at the 6-month follow-up . Good nocturnal tumescence prior to treatment was correlated with a better treatment outcome than poor tumescence We admistered the International Index of Erectile Function ( IIEF ; Rosen et al. , 1997 ) question naire to 30 patients with psychogenic erectile dysfunction ( ED ) at baseline , immediately after treatment , and 3 months after treatment . We r and omized patients into three groups : group I , who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on dem and ; group II , who had an intake of 50 mg sildenafl citrate orally on dem and for 6 months only ; and group III , who had weekly sessions of time-limited theme-based group psychotherapy for 6 months . We analyzed data ( 15-item IIEF ) for each group at three times during the study and compared by the data using analysis of variance ( ANOVA ) , followed by the Bonferroni multiple comparison test . We used Cochran 's Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms ( EF equal to or higher than 26 points ) . Group III had a mean score higher than group II , with the difference being statistically significant ( immediately after treatment , p = 0.033 ; at 3 months after treatment , p = 0.049 ; p < 0.05 ) . All three therapeutic alternatives result ed in an improvement of erectile function domain score . However , significant differences from baseline were observed in groups I ( p = 0.0009 ) and III ( p = 0.0002 ) but not in group II ( p = 0.135 ) . The psychotherapy groups , I and III , had significantly higher scores compared with group II , in which patients were exclusively treated with sildenafil citrate . These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED This study utilized a control group design to evaluate the effectiveness of group treatment of  erectile dysfunction in men without partners . Twentyone men with secondary erectile dysfunction were r and omly assigned to one of  two men 's groups with different cotherapy teams or to a waiting-list control condition . Results indicated that while the two men 's groups did not differ on any clinical - outcome measures , each men 's group improved significantly more than the waiting-list clients on a variety of measures concerning sexual attitudes and behaviors related to erectile dysfunction . Furthermore , most of the treatment gains for men 's group participants were maintained at six-week and six-month follow-up evaluations . However , the men 's group and waiting-list participants did not differ significantly in the reported frequency of erection difficulties following treatment . In comparing the present findings with those of previous studies of men 's group treatment , it is hypothesized that the absence of significant change in the frequency of erection difficulties in the present study may have been attributable to the older age of our clients or to the relative lack of emphasis on dating-skills training in this treatment format . This study illustrates the importance of including some form of no-treatment control condition in the evaluation of new treatments for sexual dysfunction A cohort of 45 patients diagnosed with predominant psychogenic erectile disorder ( ED ) chose couples psychotherapy . We r and omized 25 couples to also receive a  vacuum constriction device ( VCD ) , also known as a vacuum erectile device , at the second session ( group 1 ) , whereas 20 couples had psychotherapy without a VCD . Twentyone couples ( 84 % ) in group 1 reported some improvement after the initial psychotherapy and VCD sessions compared with 12 of the 20 couples ( 60 % ) who reported some improvement after couples psychotherapy in group 2 . We subsequently found that 3 of the 4 couples in group 1 reporting no improvement had not used the pump provided . Early combination treatment of couples psychotherapy and a physical treatment such as a VCD may lead to a greater beneficial response in men with ED than therapy alone . The delay of demonstrating the capacity and potential benefit from a physical intervention may have a marked effect on the initial and ongoing response to sex therapy Abstract Two studies on the treatment of  male sexual dysfunction  are reported . In Study I , 24 couples were placed on a 6-week waiting list and subsequently treated with systematic desensitization ( SD ) or an adaptation of the Masters and Johnson method ( sex therapy , ST ) .  Sexual function , satisfaction with the relationship , self-esteem and social anxiety were evaluated at the start of the waiting period , before and after treatment and in a follow-up . Both SD and ST led to improvement of sexual functioning , but a significant difference between treatments could not be demonstrated . Neither SD nor ST improved satisfaction with the relationship . In Study II , 32 couples were assigned to ST  or rational emotive therapy ( RET ) .  Sixteen couples dropped out of treatment . As compared with males who completed treatment , males who dropped out functioned relatively well sexually . Other differences between drop-outs and treatment-completers could not be demonstrated . In couples completing therapy , both ST and RET led to improvement of sexual functioning . Satisfaction with the relationship improved only in couples treated with RET . Significant differences between ST and RET could not be demonstrated in a valid way This study examined the effects of a sex and aging workshop highlighting permission and limited information on the sexual knowledge , attitudes , behaviors , and satisfaction of a group of older heterosexual couples experiencing erectile dysfunction . The workshop focused on disseminating information about the physiological and psychological changes that occur in the sexual response during the aging process . Twenty couples participated in this study : 10 attended a workshop and 10 served as controls .  The study utilized a r and omized control group pretest/posttest design . Workshop participants completed an evaluation form and were interviewed at the time of follow-up . Data analysis revealed that the workshop participants reported significant increases in knowledge levels and in sexual satisfaction . The workshop evaluations and follow-up interviews reinforced these quantitative results . This study lends support to educational intervention as an adjunct to treatment of erectile dysfunction in the elderly population Objective To compare the acceptance of and satisfaction with intracavernosal injection ( ICI ) therapy with and without sexological counselling in men with erectile dysfunction ( ED ) This study was a controlled evaluation of men 's group treatment of erectile dysfunction that emphasized communication and dating skills training for men without partners . Following a 6-week pretreatment waiting period , 11 men were seen for 10 sessions in two men 's groups led by different cotherapy  teams . Several female guest therapists attended three sessions to help the men role-play a sequence of difficult social interactions . A series of communication/dating homework assignments was added to the weekly sensual/sexual assignments . The results indicated no improvement during the waiting control period , but significant improvement on measures of sexual attitudes and behaviors following treatment . There was a significant reduction in the frequency of erection difficulties before intercourse and a trend toward reduction of erection difficulties during intercourse . These improvements were maintained 
    Output:
    
Treatment response appeared to vary between patient subgroups , although there was no significant difference in improvement in erectile function according to mean group age , type of relationship , and severity of ED .
There was evidence that group psychotherapy may improve erectile function .
Treatment response varied between patient subgroups , but focused sex-group therapy showed greater efficacy than control group ( no treatment ) .
In a meta- analysis that compared group therapy plus sildenafil citrate versus sildenafil , men r and omised to receive group therapy plus sildenafil showed significant improvement of successful intercourse , and were less likely than those receiving only sildenafil to drop out .
Group psychotherapy also significantly improved ED compared to sildenafil citrate alone .
Regarding the effectiveness of psychosocial interventions for the treatment of ED compared to local injection , vacuum devices and other psychosocial techniques , no differences were found