Including Your Partner - Treating Erectile Dysfunction: Mens Sexual Health

Content provided by the Faculty of the Harvard Medical School

Including your partner

First of all, talk. Talking with your spouse or sexual partner is essential. It can allow you to address any anxieties or inhibitions that may be causing or contributing to your erectile difficulties. And if you are seeking medical help, make sure to tell your partner and discuss the options and treatments together.

Many couples find it difficult to discuss their sexual relationship. But poor communication between partners often makes sexual dysfunction worse by leading to hurt feelings, anger, and withdrawal. Even if erectile impairment is initially caused by a medical problem such as diabetes, lack of communication can exacerbate the problem. For example, occasional trouble getting an erection becomes more frequent. Before long, performance anxiety sets in when you and your partner try to have sex. This can lead to depression, and the problem snowballs further. Discussing your erectile dysfunction frankly with your partner can help relieve the anxiety and improve your relationship both emotionally and sexually.

During these discussions, you may be surprised to discover that your partner has interpreted your difficulty as an insult — a sign that you no longer find your mate sexually attractive or that you have fallen out of love. Or you may discover that your partner has stopped initiating sexual contact for fear of embarrassing you. Some couples go for years with no physical contact beyond the occasional hug. Ultimately, this physical and emotional distancing causes the relationship to deteriorate. The following pattern is common among couples when sexual dysfunction becomes an issue:

• Erectile dysfunction begins.

• The couple experiences repeated, disappointing attempts at sexual intercourse.

• The man withdraws emotionally from his partner.

• The partner's self-esteem suffers because of an assumption that the man has lost interest.

• The man stops initiating sex for fear that it will lead to yet another failure.

• The couple becomes emotionally and physically estranged.

Fortunately, you can prevent this destructive pattern by talking honestly and openly with your partner. Even if you already recognize elements of this pattern taking hold in your relationship, you can reverse the damage by improving communication.

But how do you broach this subject when it's gone undiscussed for so long? First, if you plan to seek treatment for your problem, it's important to let your partner know this. If a couple isn't communicating, simply getting a prescription from a doctor and hoping for the best often fails. To begin, phrase your discussion in a way that doesn't accuse or alienate your partner.

Exactly what you say is highly personal, of course, but if you just don't know what to focus on first, you might start talking about your feelings: your understandable frustration, your sadness and regret that things have changed, and your hope for a solution. Make sure to discuss erectile dysfunction as an issue for both of you to resolve rather than as one person's problem.

If you're the partner of a man with erectile dysfunction, reassure him that his erection is not the most important part of lovemaking (see "Advice for partners"). Partners who explore other ways of making love — including massage and oral sex (which doesn't depend on erection) — often find that their sex lives become more passionate and fulfilling. Women may particularly appreciate this approach because it lengthens foreplay and often improves intimacy between couples.

Men also need to understand that it's all right if their erections come and go. Many men achieve an erection only to have it dissipate and return later. This can make a man anxious, which, in turn, can further inhibit his ability to maintain an erection. Women need to know that it's possible for men to reach orgasm without an erect penis and that manual stimulation can bring a man to climax even without a full erection.

Above all, couples need to make lovemaking a priority, not something that may or may not happen at the end of a long, tiring day. Try lovemaking on a weekend morning rather than at night. Set a regular time when both of you are likely to be feeling awake and refreshed. Setting up a regular "date" to make love may not seem spontaneous, but if spontaneity means never getting around to it or making love as the last event in an exhausting day, then give yourselves permission to plan.

If you have not had intercourse for months or years because of erectile dysfunction, you may encounter some physical difficulties once you seek treatment and attempt to resume sexual relations. If your partner is a postmenopausal woman, she may find penetration painful. That's because after menopause, vaginal tissue can become thin or atrophied and thus more susceptible to tearing, particularly if a woman hasn't been having regular intercourse. Patience is key. You may need to use lubricated fingers or dilators to gradually stretch the vaginal tissues.

Last updated:	September 05, 2008