Erectile dysfunction (ED), commonly known as impotence, can be troubling, even devastating, to a man. But it can be equally so for his partner as well, as Beth (who asked that her real name not be used) found out.
"It really undermines a relationship," says Beth, who recently broke off an engagement with a man who suffers from ED. It's especially difficult, she adds, if the man blames his partner, as her fiancé did.
"Even though my fiancé admitted that he had always had difficulties with his erections," says Beth, "he tried to tell me that it was my fault. After you hear that enough, you start to believe it, and it can really affect your self-esteem."
That's not unusual, says Karen Donahey, PhD, director of the Sex and Marital Therapy Program at Northwestern University Medical Center in Chicago. "A woman may struggle with the notion that she's no longer attractive to her man," says Donahey. "Even if the man assures her it's not true, there's still a worry there."
The stronger a woman's self-esteem is, says Donahey, the less threatened she'll feel by her partner's erectile dysfunction and the more supportive she'll be able to be.
ED Is Not Uncommon
"It's important for both men and women to realize that ED is not at all uncommon," says Donahey. Indeed, most estimates suggest that at least 50% of men in the U.S. experience some form of sexual dysfunction at some point in their lives. ED is one of the most common male sexual problems, affecting an estimated 30 million men in the U.S. and approximately 140 million men worldwide.
Though ED may indeed be common, it's still stressful, and in a study conducted by Pfizer (which makes the impotence drug Viagra), research showed that most women, where their quality of life is concerned, rank ED higher in importance than menopausal symptoms, infertility, allergies, obesity, and insomnia.
In a series of focus groups, Pfizer researchers found that when faced with ED, women -- and their partners -- either acknowledged that they had a problem or denied the existence of a problem. "While this may be intuitive, our research showed that there are differences in how women acknowledge the problem and how they deny the problem," says Janice Lipsky, PhD, senior marketing manager for the sexual health team at Pfizer.
How Couples Approach the Problem
Some couples are what Lipsky calls overcomers, with a strong desire to resolve ED. Others are resigners, who admit there is a problem but decide not to seek treatment to resolve it.
Then there are avoiders, couples who refuse to admit and discuss ED, and, finally, alienators, women who feel so angry that they not only withdraw from their relationship, but may even demean their partner or seek intimacy elsewhere.
When women are angry, says Karen Donahey, this anger is frequently present before the sexual difficulties have begun. In such instances, says Donahey, marital therapy, as opposed to sexual therapy, may be in order to get to the underlying cause of the anger.
For a woman who wants to help her partner -- as most do, says Donahey -- understanding why ED occurs can help ease her concerns as well as allow her to help her partner confront the problem, something many men are hesitant to do.
Being able to talk about it is the first step. "Opening the lines of communication is paramount" in resolving ED, says Marian Dunn, PhD, clinical associate professor and director of the Center for Human Sexuality at the State University of New York Health Science Center. "ED is not initially easy to talk about. But not talking about it can seriously damage a relationship."
Sandy (also not her real name) has been in a relationship for six months with a man who suffers from ED. "We've worked hard on handling it," she says, "and we talk about it all the time, which really helps." In addition to encouraging her partner to see his doctor for a physical exam, Sandy says that being able to talk about the situation has actually brought the two closer together.
"It defuses whatever anger and frustration there may be," she explains, "so that it doesn't carry over into other aspects of the relationship, and it has shown us that we can work on this together."
"Women don't need to take responsibility for their partner's ED," says Dr. Janice Lipsky. "But many women can and do play a critical role in supporting men to seek treatment."
Expanding Definition of Sex
One of the benefits of treatment -- be it medical or psychological, or a combination of the two -- says Donahey, is that it can educate both partners about ED. It's important to realize, for example, that just as a woman's sexual responses may change as she ages, so, too, do a man's. "A man's sexual response rate also slows down as he gets older," Donahey points out. "Whereas in his 20s, he might have been aroused simply by looking at his partner, in his 40s or 50s, he may need more direct stimulation of the penis. A woman shouldn't take this as a sign that her partner finds her unattractive."
Donahey also suggests that couples expand their definition of what sexuality is so that they can maintain their physical intimacy. "Be more flexible," she advises. "There's more to sex than just intercourse ... try manual stimulation, oral stimulation, stroking, kissing. These are all a part of an intimate relationship and can lead to an orgasm for both partners.
"Men can have an orgasm without an erection," Donahey says. "Many people don't know that, or don't believe it, but it is true."
Many couples are reluctant to even begin any kind of physical contact for fear of further disappointment. That, however, can lead to even more of a physical distance between the couple, which can eventually take its toll on the relationship. "It's important to maintain that sense of intimacy," says Donahey. "Don't make intercourse the determining factor."