Erectile dysfunction, or ED, is a common condition that can make sexual activity difficult. It may lead to a loss of intimacy in a marriage or long-term relationship, affecting the mental well-being of both partners.
According to the American Urological Association, ED affects nearly 30 million males. It can cause feelings of low self-esteem, anxiety, or depression.
In this article, we look at how ED can affect a long-term relationship, how both partners can cope, and how to support someone with ED.
ED is a condition that makes it difficult for a person to get or maintain an erection. An erection is necessary for some forms of sexual activity, including sexual intercourse.
It is not unusual to have difficulty getting an erection occasionally, but when this symptom occurs frequently, it can signal an underlying condition. Planned Parenthood list the following risk factors for ED:
- mental health conditions, such as stress, anxiety, and depression
- certain medications, which could cause ED as a side effect
- cardiovascular disease
- chronic kidney or liver disease
- diabetes
- high blood pressure
- low testosterone levels
- use of alcohol, tobacco, or other drugs
Depending on the severity of a person’s symptoms, they may not be able to have sexual intercourse as frequently or for as long as they once did. Some may not be able to have sexual intercourse at all.
Sexual intimacy can be an important part of a marriage or long-term relationship, so this change may cause anxiety or a feeling of loss for both partners. A
- depressed
- angry
- less masculine
- socially isolated
- in denial
- lacking in self-confidence
- the desire to avoid their spouse
ED also affects the mental health of a person’s partner. According to a 2016 review, ED can make a person’s partner feel confused, anxious, undesirable, or suspicious that their partner may be unfaithful.
These feelings can place strain on a relationship. ED can also be difficult to talk about due to shame or stigma, which can prevent partners from communicating openly about it.
In many cases, ED is treatable. A range of effective treatments can restore sexual function, thereby improving satisfaction in a relationship. A doctor can help couples understand their options, and they will often encourage both partners to attend appointments.
However, a person may have to try several treatments or go through testing to find an option that works for them. During this time, it is important for their partner to be open, understanding, and supportive. In one study, 94% of males felt that their partner’s support was important when dealing with ED.
Some approaches that people can try include:
- open communication
- counseling
- other forms of intimacy
- lifestyle changes
Communication
Although it can be difficult, working on open communication in a relationship can help reduce the strain of ED.
As ED can cause feelings of guilt or embarrassment, some males may avoid any type of intimacy with their partner so that they can avoid distress. However, a partner may interpret this as rejection, making them feel unwanted or unattractive.
Having a conversation about these feelings can clear up misunderstandings such as these and reassure both partners. The University of California, Los Angeles (UCLA) also suggest that partners let people with ED know that:
- ED does not make them any less masculine or desirable
- sex is not as important as the person’s health and well-being
- they are willing to work through this with the person
Counseling
Emotional distress is a common cause of ED. If a urologist believes that mental health could be a factor in a person’s ED, they may suggest counseling.
Individual counseling can give someone a private, nonjudgmental space in which to talk about their difficulties with ED. A counselor or psychologist can help a person manage feelings of stress, anxiety, or low self-esteem.
Couples counseling may also be beneficial. Some studies suggest that for 50–70% of males with stress-related ED, symptoms improve when their partner attends therapy with them.
Couples counseling can help partners learn how to communicate with and support each other, and it may help resolve any relationship problems that could be affecting sexual intimacy.
Other forms of intimacy
There are ways to maintain physical intimacy while someone undergoes treatment for ED. For example, nonsexual touching, which includes kissing, cuddling, and hand-holding, can make people feel closer and help people with ED feel supported.
The UCLA also suggest experimenting with other forms of sexual activity. Doing this can help both partners experience pleasure without the need for penetration. It may also reduce pressure on the male to “perform,” and so lessen performance anxiety.
Lifestyle changes
As part of treatment, a person with ED may need to make certain lifestyle changes,
- stopping smoking, if a smoker
- limiting or eliminating alcohol intake
- increasing exercise
- maintaining a moderate body weight
- stopping illegal drug use, if relevant
Those in a relationship with someone with ED can help their partner do this by providing moral support. In some situations, it may be beneficial for them to participate in the changes, too.
For example, if a doctor recommends dietary changes to someone with ED, it may be easier for the person to stick to them if their partner also adopts some or all of the changes. Similarly, if both partners smoke, it can be helpful, as well as beneficial healthwise, for both to stop smoking.
People who have a partner or spouse with ED can have their own difficulties with mental health. They may worry that the inability to maintain an erection is a sign that their partner no longer desires them.
However, low libido is a separate condition from ED. Someone with low libido does not want to have sex, whereas people with ED may wish to but be unable. If someone with ED is not interested in sex anymore, it may be due to the effect that ED is having on their mental state.
A partner can cope by remembering that ED is often not personal and that it is okay for them to talk with a professional about how their partner’s ED makes them feel. It may help to discuss the issue with a urologist, counselor, or other individuals in the same situation.
Many medical treatments are available for ED. However, the best option will depend on what is causing the ED. It is a good idea for both partners to learn about the treatment options and what they involve.
Noninvasive treatments
Noninvasive treatments for ED include:
- oral medications, such as sildenafil (Viagra)
- injectable medications, such as alprostadil (Caverject) or the combination drug TriMix
- suppositories that a person inserts into the urethra
- testosterone therapy for low testosterone levels
- vacuum or pump devices that draw blood into the penis, making it possible to maintain an erection temporarily
If a medication might be causing ED as a side effect, changing this medication may also be an option. It is essential always to discuss this with a doctor first.
Surgery
Penile implant surgery involves a surgeon placing implants into the penis that make it possible for the penis to stay rigid during sex. These devices include inflatable implants and semirigid implants.
Inflatable implants allow someone to create an erection by pumping fluid into the penis. A person can inflate or deflate the implants in the penis using a pump, which a surgeon inserts into the scrotum. In contrast, semirigid implants are somewhat firm all the time.
If necessary, surgery to reconstruct the arteries may also help improve blood flow.
A person should see a doctor if they frequently have trouble achieving or maintaining an erection. ED can sometimes be a symptom of an underlying health condition,
- type 2 diabetes
- cardiovascular disease
- chronic kidney disease
- multiple sclerosis (MS)
- Peyronie’s disease, in which scar tissue builds up under the skin of the penis
- injury to the penis, bladder, spinal cord, prostate, or pelvis
ED can also be a side effect of certain medications. A person who experiences ED after beginning a new medication should discuss alternatives with their doctor.
Both people in a marriage or long-term relationship can find it difficult to deal with one partner’s ED. However, numerous effective treatments are available. Support from a partner can be very beneficial for someone undergoing ED treatment.
Having open, honest discussions and finding other ways to connect can help a couple retain or regain intimacy and closeness. People who have difficulty with this may benefit from talking to a couples counselor, who can offer advice on ways to cope.