Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Cognitive behavioral therapy as an adjunct treatment for Pakistani men with ED



The goal of this study was to determine potential positive effects of cognitive behavioral therapy (CBT) on Pakistani men with ED who were undergoing treatment with a PDE-5 inhibitor. We used a pre-post research design comparing men with and without adjunctive CBT. Men in the two groups were compared to determine whether CBT improved sexual function, as measured by the International Index of Erectile Function (IIEF). A total of 60 individuals diagnosed with ED completed the study. Participants were systematically assigned to one of two groups, the CBT group or the control group. The sample was drawn from outpatients referred through several hospitals in Islamabad. All men showed improvement in sexual functioning over the course of the study, though post treatment, men in the CBT group showed greater improvement on IIEF subscales of erectile functioning, orgasmic function, intercourse satisfaction and overall satisfaction than those in the control group. CBT can be considered an effective and supportive means for achieving better sexual outcomes for Pakistani men taking PDE-5 inhibitors for erectile problems.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1

    Chou PS, Chou WP, Chen MC, Lai CL, Wen YC, Yeh K et al. Newly diagnosed erectile dysfunction and risk of depression: a population‐based 5‐year follow‐up study in Taiwan. J Sex Med 2015; 12: 804–812.

    Article  Google Scholar 

  2. 2

    Rowland DL, Wedding D (ed.). Sexual Dysfunction in Men: Advances in Psychotherapy Evidence-Based Practice. Hogrefe Publishing: Cambridge, MA, USA, 2012.

    Google Scholar 

  3. 3

    Trudel G, Goldfarb MR . Marital and sexual functioning and dysfunctioning, depression and anxiety. Sexologies 2010; 19: 137–142.

    Article  Google Scholar 

  4. 4

    Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J . Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav 2013; 42: 915–933.

    Article  Google Scholar 

  5. 5

    Rowland DL, Adamski BA, Neal CJ, Myers AL, Burnett AL . Self-efficacy as a key construct in understanding and treating sexual dysfunction. J Sex Marital Ther 2015; 1: 66–71.

    Google Scholar 

  6. 6

    Khan N . Dhat syndrome in relation to demographic characteristics. Indian J Psychiatry 2005; 47: 54–57.

    Article  Google Scholar 

  7. 7

    El-Sakka AI . Erectile dysfunction in Arab countries. Part I: prevalence and correlates. Arab J Urol 2012; 10: 97–103.

    Article  Google Scholar 

  8. 8

    Oyelade BO, Jemilohun AC, Aderibigbe SA . Prevalence of erectile dysfunction and possible risk factors among men of South-Western Nigeria: a population based study. Pan Afr Med J 2016; 24: 124.

    PubMed  PubMed Central  Google Scholar 

  9. 9

    Miller TA . Diagnostic evaluation of erectile dysfunction. Am Fam Physician 2000; 61: 95–104.

    CAS  PubMed  Google Scholar 

  10. 10

    Ayta IA, McKinlay JB, Krane RJ . The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999; 84: 50–56.

    CAS  Article  Google Scholar 

  11. 11

    Laumann EO, Paik A, Rosen RC . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    CAS  Article  Google Scholar 

  12. 12

    American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 5th edn. American Psychiatric Association: Washington DC, USA, 2013.

  13. 13

    Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000; 30: 328–338.

    CAS  Article  Google Scholar 

  14. 14

    Conaglen HM, Conaglen JV . Drug induced sexual dysfunction in men and women. Aust Prescr 2013; 36: 42–45.

    Article  Google Scholar 

  15. 15

    McCabe M . Evaluation of a cognitive behavioral therapy program for people with sexual dysfunction. J Sex Marital Ther 2001; 27: 259–271.

    CAS  Article  Google Scholar 

  16. 16

    Rosen I . Symposium on sexual dysfunction. The psychoanalytical approach. Br J Psychiatry 1982; 140: 85–93.

    CAS  Article  Google Scholar 

  17. 17

    Berry MD . The history and evolution of sex therapy and its relationship to psychoanalysis. Int J Appl Psychoanal Studies 2013; 10: 53–74.

    Article  Google Scholar 

  18. 18

    Ellis A . Group rational-emotive and cognitive-behavioral therapy. Int J Psychother 1992; 42: 63–80.

    CAS  Article  Google Scholar 

  19. 19

    Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A . The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res 2012; 36: 427–440.

    Article  Google Scholar 

  20. 20

    Cyranowski JM, Aarestad SL, Andersen BL . The role of sexual self-schema in a diathesis-stress model of sexual dysfunction. Appl Prev Psychol 1999; 8: 217–228.

    Article  Google Scholar 

  21. 21

    Corretti G, Baldi I . The relationship between anxiety disorders and sexual dysfunction. Psychiatric Times 2007; 24: 16–21.

    Google Scholar 

  22. 22

    Rowland DL, Gutierrez B . Psychosexual therapy in perspective: strategies for the non-specialist counselor. In: Brewer D (ed.). Psychotherapy: Methods, Outcomes, and Future Directions. Nova Science Publishers: Hauppauge, NY, 2016, pp 15–44.

    Google Scholar 

  23. 23

    Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J . Combination of psychological intervention and phosphodiesterase‐5 inhibitors for erectile dysfunction: a narrative review and meta‐analysis. J Sex Med 2014; 11: 1376–1391.

    CAS  Article  Google Scholar 

  24. 24

    Andersson KE . Pharmacology of penile erection. Pharmacol Rev 2001; 53: 417–450.

    CAS  PubMed  Google Scholar 

  25. 25

    Wylie K, MacInnes I . Erectile dysfunction. In: Balon R, Segraves RT (eds). Handbook of Sexual Dysfunction. Taylor & Francis: Boca Raton FL, USA, 2005, pp 155–192.

    Google Scholar 

  26. 26

    Perelman M . Combination therapy for sexual dysfunction: integrating sex therapy and pharmacotherapy. In: Balon R, Segraves RT (eds). Handbook of Sexual Dysfunction. Taylor & Francis, Boca Raton FL, USA, 2005, pp 13–41.

    Google Scholar 

  27. 27

    Perelman M . Integrated sex therapy: a psychosocial-cultural perspective integrating behavioral, cognitive, and medical approaches. In: Carson CC, Kirby RS, Goldstein I, Wyllie MG (eds). Textbook of Erectile Dysfunction, 2nd edn, Informa Healthcare, London, UK, 2009, pp 298–305.

    Google Scholar 

  28. 28

    Ahmer S, Khan F, Bhimani M . Psychiatric presentations of sexual dysfunction in Pakistan. J Pakistan Psychiatr Soc 2010; 7: 18.

    Google Scholar 

  29. 29

    Shaeer KZM, Osegbe DN, Siddiqui SH, Razzaque A, Glasser DB, Jaguste V . Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria. Int J Impot Res 2003; 15: S8–S14.

    Article  Google Scholar 

  30. 30

    Faul F, Erdfelder E, Lang AG, Buchner A . G *Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175–191.

    Article  Google Scholar 

  31. 31

    Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E . Standard operating procedures for taking a sexual history. J Sex Med 2013; 10: 26–35.

    Article  Google Scholar 

  32. 32

    Rosen R, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.

    CAS  Article  Google Scholar 

  33. 33

    Veit CT, Ware JE . The structure of psychological distress and well-being in general populations. J Consult Clin Psychol 1983; 51: 730–742.

    CAS  Article  Google Scholar 

  34. 34

    McCabe MP, Price E, Piterman L, Lording D . Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction. Int J Impot Res 2008; 20: 324–330.

    CAS  Article  Google Scholar 

  35. 35

    Hart TA, Schwartz DR . Cognitive-behavioral erectile dysfunction treatment for gay men. Cogn Behav Pract 2010; 17: 66–76.

    Article  Google Scholar 

  36. 36

    Shaeer O, Shaeer K . The global online sexuality survey (GOSS): erectile dysfunction among Arabic-speaking internet users in the Middle East. J Sex Med 2011; 8: 2152–2163.

    Article  Google Scholar 

Download references


We acknowledge the support of Dr Uzma Masroor, Head of Department, Department of Professional Psychology, Bahria University, Islamabad. We also thank the cooperating health professionals at the regional hospitals, especially Dr Najam Akhtar (psychiatrist), Dr Sohail Ahmed Khan (dermotologist) and Dr Safia Ashfaq (clinical psychologist) for their referrals.

Author information



Corresponding author

Correspondence to D Rowland.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Khan, S., Amjad, A. & Rowland, D. Cognitive behavioral therapy as an adjunct treatment for Pakistani men with ED. Int J Impot Res 29, 202–206 (2017).

Download citation

Further reading


Quick links