Electronic Journal of Human Sexuality, Volume 3, June 30, 2000


Book Review

Erectile Dysfunction. Integrating Couple Therapy, Sex Therapy, and
Medical Treatment

By Gerald R. Weeks & Nancy Gambescia (2000) Norton
ISBN: 0-393-70330-4; 201 pages, USA $30, CAN $42

Reviewed by Annette Fuglsang Owens, MD PhD
To buy this book, see link at bottom of review.

The Authors:
Gerald Weeks, Ph.D. is a professor at the University of Las Vegas and is the author of numerous books on sex and marital therapy. Nancy Gambescia, Ph.D., teaches the treatment of sexual dysfunctions to therapists and has a private practice focusing on marital and sex therapy in Bryn Mawr, Pennsylvania.

The Audience:
The book is mainly targeted towards health professionals who come into contact with clients affected by erectile difficulties. General readers may find some valuable information on erectile dysfunction, its assessment, and various treatment options.

The book begins with an overview of issues and concerns surrounding erectile dysfunction (ED), including a very good list of misconceptions about erections and a discussion of why someone with ED may be reluctant to seek professional help. Emphasis is on ED being a couples' problem, and that couple/marital therapy should go hand in hand with sex therapy and sometimes medical treatment.

The authors present sex therapy and couple/marital therapy as two separate and non-inclusive fields. True, the two areas may have developed independently from each other and still be "…professionally, academically, and organizationally separate (p.3)…" However, I believe that the two fields have already merged to a greater extent than Weeks & Gambescia recognize. Many professionals have been trained and certified in both areas. It is obvious that most sexual difficulties present themselves in the context of a relationship, and someone's sex-life, including its strength and weaknesses, simply cannot be properly dealt with out of this context.

Following is a chapter on the medical aspects of ED. The information presented in this chapter may in particular be useful for mental health professionals who wish to familiarize themselves with the most recent advances in the medical treatment of ED. This chapter may also prove useful for a person affected by ED, as it provides information regarding different treatment options. The chapter offers a good discussion, but there are a few minor errors:

     1) "…Erections are often present during rapid eye movement (REM) sleep and also when a man awakens from sleep with a full bladder (p. 16)…" Authorities generally agree that the latter statement is a myth, and only REM sleep is associated with erections.

     2) In the paragraph on Sildenafil (Viagra) it is stated that: "…Sildenafil promotes the release of nitric oxide and inhibits the breakdown of cyclic GNP… (p. 36)." GNP is repeated several times in this paragraph and should be GMP, short for cyclic guanosine monophosphate. To the eye of anyone familiar with the correct term, this minor error corresponds to saying UPA instead of USA. Also, Viagra does not promote the release of nitric oxide, the substance responsible for increased blood flow to the penis during erections; it simply enhances its effects by inhibiting the enzyme responsible for its breakdown.

For the remainder of the book, which deals with the psychological aspects of ED, I have nothing but praise. The authors clearly demonstrate their experience and expertise in providing sex therapy for couples affected by ED. Psychological and interactional or dyadic risk factors for ED and their assessment are reviewed. Basic principles, strategies and techniques for sex therapy with couples are discussed. Clinical examples of therapeutic questions and excerpts of dialog between therapist and client add further understanding to the theoretical aspects presented in this outstanding section of the book.

The chapter "Integrating Psychological and Medical Treatments" guides health professionals on how to combine various treatment options in order to optimize the effect for the client. A typical example is to prescribe Viagra in order to break through performance anxiety. The male may become more sexually confident and competent, and as a result be more receptive towards some techniques used in sex therapy. Also, other possibly co-existing difficulties such as premature ejaculation, lack of desire, and orgasmic difficulties can sometimes be dealt with more effectively if the man's erectile difficulties have been by-passed with Viagra.

One of the final chapters deals with common pitfalls therapists encounter and how to avoid them. A number of suggestions, such as "Don't take sides," "Don't intervene too quickly," and  "Don't answer questions until you are ready," serve as excellent reminders for the health care provider and can be applied in more general terms when dealing with issues other than ED.

Last, valuable guidelines and tools for dealing with communication difficulties and anger between partners are presented.

The fields of marital therapy, sex therapy, and medicine will merge further as a result of this book. I can highly recommend it to health care providers with different training backgrounds dealing with clients affected by ED. They will find valuable information, guidelines and instructions on how to integrate various treatment options for ED, thereby optimizing their clients' treatment.

Erectile Dysfunction: Integrating Couple...