Sex Counseling and the Penile Prosthesis David G. Bullard, Ph.D. Jay Mann, Ph.D. Harvey Caplan, M.D. Jean M. Stoklosa, R.N., M.S. ABSTRACT: Surgical implantation of the penile prosthesis raises critical issues for the assessment and treatment of psychogenic and organically based erectile dysfunction. The importance of treating sexual problems within the overall context of an individual's personal and interpersonal experience is discussed and illustrated with case studies. A regimen of sex counseling is suggested t) to aid in the differential diagnosis of a psychological from an organic basis for the dysfunction--thereby being likely to correct the problem in the former instance; 2) to provide an opportunity for the client and his partner to explore other satisfying forms of sexual expression and communication; and 3) to increase the probability of successful adaptation if a prosthesis is requested by the client. The following question was recently posed to us as sex therapists and educators: to what extent should a person seeking a surgical solution for erectile dysfunction secure psychological evaluation and counseling? As new techniques such as surgical implantation of penile prostheses are developed, refined and utilized, 1-3, such questions become increasingly important in medical decision making, The opinions which form the basis for this paper are derived from our current and past experience working at the Sex Counseling Unit of the Human Sexuality Program at the University of California Medical Center, San Francisco. As a group, we believe that a surgical approach to the treatment of erectile dysfunction should be used only after its suitability for the Preparation of this report was supported, in part, by Grant MH14346-02, NIMH. Drs. Bullard and Caplan are affiliated with the Human Sexuality Program, Department of Psychiatry, University of California, San Francisco. Dr. Mann is affiliated with the Family Study Unit, Veterans Administration Hospital, Palo Alto. Ms. Stoklosa is affiliated with the Health Systems Research and Planning Group, Veterans Administration Hospital, San Francisco. Requests for reprints may be sent to David G. Butlard, Ph.D., Sex and Disability Training Project, 814 Mission Street, Second Floor, San Francisco, California 94103. 184 Sexuality and Disability, Volume I, Number 3, Fall 1978 0146.I044/78/1500-0184 $00.95 © 1978 Human Sciences Press