Managing Erectile Dysfunction from the Point of View of the Couple

Béatrice Cuzin
European Endocrinology, 2006:1-3
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“Couples are wholes and not wholes, what agrees disagrees, the concordant is discordant. From all things one and from one all things.”
Heraclitus of Ephesus (540–480BC)

These words illustrate the complexity and necessity to consider a couple as a whole; nevertheless respecting each individual. There has been limited research on sexual dysfunction in the couple, and on the sexual functioning of one member of the couple influencing the libido of the partner.

Studies on Sexual Dysfunction

Traditionally, sexual dysfunction clinical research has focused on erectile dysfunction (ED), and on men’s experiences of ED and the improvements to their sexual function following treatment. More recently, research has begun to look at female sexual dysfunction, and the issue of ED and its treatment from the woman’s perspective has also been addressed. Some studies have assumed that ED is a shared sexual dysfunction that is distressing for men who experience the condition as well as for their partners,1-3 and have examined the adverse effects of ED on a female partner’s sexual functioning and sexual satisfaction.4-6 The Index of Sexual Life (ISL) questionnaire was developed and validated by Chevret et al. to measure a woman’s sexual satisfaction and desire in relation to her partner’s ED.2 Findings indicate that the partners of men with ED reported a significantly decreased sexual drive and sexual satisfaction compared with those women whose partners did not have ED.7 Studies that have explored female sexual dysfunction suggest that women partners of men with ED are themselves more likely to have sexual dysfunction or to cease sexual activity entirely.3,5,8,9 A study comparing the views of female partners of men with ED (organic and non-organic) found that dyspareunia and vaginismus were more common in female partners of men with non-organic ED.10 More recently, the sexual experience of female partners of men with ED has been examined, alongside a male study.11 Women reported engaging in sexual activity much less frequently after their partner developed ED in comparison with before. Moreover, significantly fewer women experienced sexual desire, arousal or orgasm ‘almost always’ or ‘most times’, and the majority of women reported dissatisfaction with their sexual relationship after their partner developed ED. Decreases in female sexual satisfaction and frequency of orgasm were related to the male partner’s self-reported severity of ED. The proportion of women who experienced sexual desire, arousal and orgasm ‘almost always’ or ‘most times’ was significantly higher in the group whose partners were currently using a phosphodiesterase type-5 (PDE-5) inhibitor. Moreover, a randomised study has been published concerning the quality of the sexual life of couples affected by ED using PDE-5 treatment, which showed that erectile function in men with ED, subjective arousal, lubrication, orgasm and satisfaction in untreated women partners and overall quality of sexual life improved together.12,13 ED management should therefore include both partners.

References:
  1. Fisher W, Meryn S, Sand M, et al., “Communication about erectile dysfunction among men with ED, partners of men with ED, and physicians: The Strike Up a Conversation study-Part I”, J Men’s Health Gend (2005);2(3): pp. 64–78.
  2. Chevret M, Jaudinot E, Sullivan K, et al., “Impact of erectile dysfunction (ED) on sexual life of female partners: Assessment with the Index of Sexual Life (ISL) questionnaire”, J Sex Marital Ther (2004);30(3): pp. 157–172.
  3. Montorsi F, Althof S E, “Partner responses to sildena.l citrate (Viagra) treatment of erectile dysfunction”, Urology (2004);63(4): pp. 762–767.
  4. Dorsey G, “Partners’ perspective of erectile dysfunction: Literature review”, Br J Nurs (2001);10(3): pp. 187–95.
  5. Ichikawa T, Takao A, Manabe D, et al., “The female partner’s satisfaction with sildena.l citrate treatment of erectile dysfunction”, Int J Urol (2004);11(9): pp. 755–762.
  6. Riley A, “The role of the partner in erectile dysfunction and its treatment”, Int J Impot Res (2002);14(suppl. 1): pp. S105–109.
  7. Cayan S, Bozlu M, Canpolat B, Akbay E, “The assessment of sexual functions in women with male partners complaining of erectile dysfunction: Does treatment of male sexual dysfunction improve female partner’s sexual functions?”, J Sex Marital Ther (2004);30(5): pp. 333–341.
  8. Blumel J E, Castelo-Branco C, Cancelo M J, et al., “Impairment of sexual activity in middle-aged women in Chile”, Menopause (2004);11(1): pp. 78–81.
  9. Greenstein A, Abramov L, Matzkin H, Chen J, “Sexual dysfunction in women partners of men with erectile dysfunction”, Int J Impot Res (2006);18(1): pp. 44–46.
  10. Speckens A E, Hengeveld M W, Nijeholt G, et al., “Psychosexual functioning of partners of men with presumed nonorganic erectile dysfunction: Cause or consequence of the disorder?”, Arch Sex Behav (1995);24(2): pp. 157–172.
  11. Fisher W A, Rosen R C, Eardley I, et al., “Sexual experience of female partners of men with erectile dysfunction: the female experience of men’s attitudes to life events and sexuality (FEMALES) study”, J Sex Med (2005);2(5): pp. 675–684.
  12. Fisher W A, Rosen R C, Mollen M, et al., “Improving the sexual quality of life of couples affected by erectile dysfunction: a double-blind, randomized, placebo-controlled trial of vardenafil”, J Sex Med (2005);2(5): pp. 699–708.
  13. Goldstein I, Fisher W A, Sand M, et al., “Vardenafil Study Group. Women’s sexual function improves when partners are administered vardenafil for erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial”, J Sex Med (2005);2(6): pp. 819–832.
  14. Shabsigh R, Klein L T, Seidman S, et al., “Increased incidence of depressive symptoms in men with erectile dysfunction”, Urology (1998);52: pp. 848–852.