Abstract Introduction Psychogenic erectile dysfunction (ED) is common among young and middle-aged men and is often maintained by performance anxiety, maladaptive beliefs, and conditioned avoidance of sexual activity. Although cognitive-behavioral therapy (CBT) remains the gold-standard approach, many patients cannot engage in conventional couple-based interventions or are reluctant to use pharmacological treatments because of side effects or personal preference. For these individuals, structured behavioral protocols that allow gradual and controlled exposure to sexual situations can provide a safe and effective therapeutic alternative. This study evaluated a novel systematic desensitization (SD) program based on progressive exposure principles, using a CE-certified constriction-ring system designed to restore erectile confidence and reduce anxiety related to sexual failure. Objective To assess the clinical efficacy and satisfaction outcomes of a structured, non-pharmacological desensitization protocol for men with psychogenic ED. Methods A prospective pre–post study was conducted in an outpatient sexual health setting with sixteen men aged 23–56 years who met DSM-5 criteria for psychogenic erectile dysfunction and had not received prior ED treatment. The 12-week protocol combined cognitive-behavioral and psychoeducational guidance with the progressive use of constriction rings of decreasing compression (Intense → Firm → Light), followed by a phase without device use. Before starting the intervention, participants attended an introductory session explaining correct device placement, hygiene, safety limits for compression and duration, and how to record weekly observations. Erectile function was assessed using the International Index of Erectile Function (IIEF-5), and satisfaction through the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and its partner version (EDITS-P). Given the small sample size and non-normal distribution, Wilcoxon signed-rank tests were used for pre–post comparisons, with p 0.05 considered statistically significant. Results All sixteen participants completed the study without adverse events. Mean IIEF-5 scores increased from 11.6 ± 3.1 (moderate–severe ED) to 21.2 ± 4.0 after treatment, showing a mean improvement of 9.6 points (Z = 3.52, p 0.001), indicating statistically significant differences in erectile function. Thirteen participants (81 %) achieved clinically meaningful improvement (≥ 4-point increase), and eleven (69 %) reached scores consistent with normal erectile function. Mean satisfaction was high (EDITS = 90.4 ± 9.3 %), mirrored by partner satisfaction (EDITS-P = 86.7 ± 10.1 %). Participants reported reduced anticipatory anxiety, enhanced confidence, and maintenance of spontaneous erections during follow-up without device use. Conclusions The structured use of a graduated constriction-ring system within a behavioral framework produced statistically significant improvements in erectile function and satisfaction in men with psychogenic ED. This low-risk, easily replicable intervention may be particularly beneficial for patients unable to participate in conventional couple-based therapy or reluctant to use pharmacological options. These findings support systematic desensitization as a practical and promising approach to restore sexual confidence and reduce anxiety-driven dysfunction. Larger controlled studies are warranted to confirm efficacy and long-term outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Myhixel
Rodriguez et al. (Mon,) studied this question.