IT TAKES TWO: A Couples Guide to Erectile Dysfunction

Sexual Function Health Council

A pamphlet, created by the Sexual Function Health Counsel, to help couples face Erectile Dysfunction (ED). This includes basic information about the medical side ED as well as the emotional aspects that couples may face.

Confronting Erectile Dysfunction as a Team
Experts agree that good communication is the foundation for an enduring relationship. However, when couples encounter sexual difficulties, communication in the best of relationships can become strained or break down entirely. Erectile dysfunction may divide and distance couples, often causing conflict and emotional pain. Couples may intentionally or unintentionally ignore or deny the condition, thus delaying treatment. Fortunately, many sexual difficulties can be improved or resolved through open communication and a mutual commitment to learn about the condition and treatment options. The first step in addressing erectile dysfunction, as partners, is to understand the definition of the condition and acknowledge its existence. In 1992, the National Institute of Health defined erectile dysfunction as the inability to sustain or achieve an erection. This definition is more precise than impotence, a term that some associate with being sterile or lacking strength, vigor or power. Overcoming erectile dysfunction is best achieved when a man and his partner openly communicate, continue to demonstrate love and affection and have a mutual desire to carry through with treatment options. This brochure has been developed to help couples learn more about erectile dysfunction and the treatment options available. It is hoped this brochure will promote dialogue and encourage couples to seek a knowledgeable and caring physician to discuss treatment options for this condition.

What is Erectile Dysfunction?
Erectile Dysfunction (ED) also known as impotence is the ability to achieve or sustain an erection adequate for sexual intercourse. ED is a common, treatable condition affecting an estimated 18 million men in the United States alone. Yet, data suggest that less than 10 percent of affected men actually receive treatment. The small number who receive treatment is thought to be related to the reluctance of many men to discuss the subject with their doctor. In addition, some physicians are not comfortable addressing the topic with their patients.

What Causes Erectile Dysfunction?
Most men experience occasional erectile failures at some time during their lives, usually as a result of fatigue, temporary stress or excessive alcohol consumption. Temporary loss of erectile capability is not something to worry about. However when the condition persists or interferes with a man's normal sexual activity, medical advice should be sought. Until recently, many in the health care profession believed erectile dysfunction was caused by mental or emotional conflicts. Patients were often told, "It's all in your head." Today, experts believe that up to 70 percent of all ED cases may be due to physical conditions with psychological factors accounting for the remaining 30 percent. In many cases, however, there are both psychological and physical reasons for the condition.

Men with ED of physical origin often experience a gradual onset of symptoms. Physical causes of ED include:

Blockage of the arteries
Diabetes
Neurological disorders
Disease of the erectile tissue of the penis
Pelvic surgery and/or trauma
Side effects of medications
Chronic disease (such as kidney or liver failure)
Hormonal abnormalities
Alcoholism and drug use
Heavy smoking

Men who experience a sudden loss of erectile capability often have a psychological origin to their condition. Just as an erection can result from thinking about sex, negative thoughts can prevent an erection from occurring. Typically, patients whose ED is primarily psychological in nature continue to have erections while sleeping or when the get up in the morning. Psychological causes of impotence include:
Stress and anxiety from work or home
Worry about poor sexual performance
Marital discord
Unresolved sexual orientation
Depression

Whether a man's erectile dysfunction is caused by physical or psychological factors, or a combination of the two, it may become a source of mental, emotional and physical stress. In addition, ED may also be a symptom of more serious conditions such as heart disease or diabetes.

What Doctors Treat ED?
Doctors most qualified to treat ED are those who regularly diagnose and treat the condition and who stay up to date on the latest ED research and treatments. As a group, urologists are the most knowledgeable about ED. Many psychiatrists and psychiatrists and psychologists also treat the condition. Whoever is consulted should be both knowledgeable about the condition and have an understanding of its potential impact on the man and his partner. It is also important the medical professionals discuss the pros and cons of all treatment options with their patients.

Can Someone be too Old for Treatment?
Attitude, not age is the biggest barrier in treating erectile dysfunction. Some men who experience difficulty producing an erection may see the condition as a natural, unchangeable part of aging. Instead of seeking treatment, many men resign themselves to the condition by making excuses, such as: "I'm too old", or "I'm not interested anymore" or "I have better things to do." Fortunately, more and more information is becoming available to help men of any age realize that treatment options are available to treat ED.

Should Couples Seek Treatment Together?
Some men prefer to deal with their erectile dysfunction with no help or assistance for their partner; some even seek medical advice and treatment without their partner's knowledge. Yet, most doctors acknowledge that a couple's chances for a mutually beneficial approach to treating ED are much better when they work together. The partnership can begin with a visit to a physician.

What Happens during the First Visit?
The first visit with the doctor often involves a complete exam. This exam will probably include a detailed medical and sexual history, followed by a physical examination and basic laboratory tests. The results of the exam will help the doctor determine the cause and extent of the condition and suggest possible treatment options. What ever treatment is selected, the partner can play an important supporting role for the patient.

How Are Men Affected by ED?
The ability to function sexually helps to define a man's role in the world, thus shaping his identity. It's no wonder then, that the loss of erectile capability can have a profound effect on a man.
Many men with ED suffer emotionally, often in silence. They may say to themselves: "If I can't have a normal sex life with my partner, I'm a failure as a man and a lover." Or they may worry, "Will she leave me if I don't satisfy her?" Such concerns may contribute to feelings of anxiety, shame and frustration.

How Are Partners Affected by ED?
> Because of the emotional pain associated with ED, it's common for men to make excuses to avoid sexual situations with their partners in an effort to forget about the condition. Whether intentional, or unintentional, these actions can make a woman feel inadequate within the relationship, often resulting in rejection, loneliness and depression. Some women may fear they are no longer attractive to their partner, or that his attitude is the result of something she may have done. Others may worry, "Is something wrong with our relationship?" or "Is he having an affair?" Thus, a man's failure to communicate his condition may contribute to feelings of anxiety or depression in his partner, or lead her to express anger and frustration.

How Can Couples Work Together?
In order to appropriately treat ED and strengthen a healthy and nurturing relationship, couples need to communicate openly and honestly with each other. Most importantly, couples need to confront any concerns they may have about ED by discussing their feelings and reassuring each other that they still care. Couples need to maintain this communication throughout the treatment process.

What ED Treatments Are Available?
Currently, there are a number of lifestyle changes and treatment options available for men with erectile dysfunction. A physician can explain the best course of treatment. In some cases, the first course of treatment satisfies the patient and his partner. For other patients a number of steps may be taken before one is found satisfactory. Among the proven treatment options are:
Changing habits and medications
Quitting smoking can be an important step in reducing the impact of impotence or eliminating it altogether. Changing prescription medications may also help address the condition.

Hormone Medications
Only five percent of erectile dysfunction cases are caused by irregular levels of sex hormones, such as low levels of testosterone, excess prolactin and excess estrogen. Fortunately, for men who experience ED as a result of unbalanced hormone levels, there are medications that can restore this balance.

Professional Counseling
Because erectile dysfunction can often result from a combination of psychological and physical factors, counseling can lessen anxiety, which in turn may reduce the impact and duration of the condition. This therapy is often used in combination with the other treatments directed by a physician.

Vacuum Devices
This treatment involves the use of an external vacuum device and one or more tensions rings (basically rubber bands). The device works by inserting the penis into a plastic cylinder, which is then pumped to create a controlled vacuum. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection; the vacuum device is then removed. The erection-like state generally lasts long enough for the couple to have intercourse.

Injection Therapy
One of the newest forms of treatment involves the self-injection of medication into the sides of the penis. The relatively painless injection produces erections of good quality for about 70-80 percent of patients. There are several injectable medications that, when used alone, help increase blood flow to the penis which promotes an erection. Originally, these medications had been registered and marketed to treat other conditions. Researchers, however, also found them to be effective in treating erectile dysfunction, so doctors began prescribing these medications for their patients.

Penile Prostheses
This treatment involves the surgical placement of a stationary movable device into the two sides of the penis, allowing erections as often as desired. These implants come in two forms: an inflatable device and semi-rigid rods. This treatment is not recommended until other methods have been considered or tried first.

Oral Therapy
Yohimbine occurs naturally in the bark of evergreen trees and has been used as an aphrodisiac for centuries by Indians and Africans. It is believed the drug works by enhancing nerve sensitivity in the penis. While there have been no large scale studies to prove the drug's effectiveness, a small percentage of men report it to be helpful for erectile dysfunction.
Surgical Treatment
This treatment is usually reserved for those patients whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery is also used to correct ED caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections will occur naturally.

Regaining Sexual Function
The good news for many men and their partners is that erectile dysfunction can usually be treated safely and effectively. In light of recent medical advances, men no longer need to suffer from erectile dysfunction in silence, nor must their impotency be a dividing force in their relationships. Most importantly, couples can now fully enjoy the enriching and exhilarating joy of intimate sexual contact. The key to regaining long-term sexual function is trust and open communication between the motivated man and his supportive partner. Success also requires a knowledgeable and caring health care professional, one who understands both the physical and psychological impact of the condition on both the patient and his partner. With the teamwork, communication and a mutual commitment to regaining sexual function, many couples can experience renewed passion and excitement in their physical and emotional relationship.

Sexual Function Health Council American Foundation for Urologic Disease