Women Suffer from Erectile Dysfunction, Too

We received this submission from UK-based kindred spirits, looking to maintain intimacy for women--and their partners--just as long as they choose.

Erectile dysfunction affects millions of men in the UK and there is often embarrassment surrounding the issue. Erectile dysfunction is when a man cannot get or maintain an erection which makes engagement in intercourse impossible. In fact, the NHS estimate that 50 percent of men aged between 40 and 70 will suffer from erectile dysfunction at least once in their life.

The main causes of erectile dysfunction are both psychological and physical. Sometimes hormones can be the problem, as can high blood pressure and high cholesterol which cause the blood vessels to narrow and sometimes erectile dysfunction can occur as a result of surgery or an injury. Not only can erectile dysfunction be a symptom of other health problems, it can also be the cause of psychological effects. Erectile dysfunction can have a serious effect on a man's mental well-being, because it can damage his self-esteem. However, the relationship between erectile dysfunction and psychological issue can be seen as a vicious circle; not only can erectile dysfunction be the cause for reduced self-esteem and depression, but anxiety and depression are also listed as common causes of erectile dysfunction.

It's not just men who are psychologically affected by erectile dysfunction, either. Women can get emotionally hurt when their partner is unable to get an erection or maintain one, because they blame themselves and think they could be doing something differently to help their partner. Sometimes women feel rejected when their partner suffers from erectile dysfunction, assuming that their partner can't get an erection because they are not adequately aroused.

Of course this does not help make the situation any less stressful for the male suffering from erectile dysfunction and the situation is often made worse. Relationship problems can often occur as a result, because tense situations arise and couples are too embarrassed to talk about the issue.

According to clinical psychologist Mark L. Held, PhD, the best thing to do is talk about erectile dysfunction before it becomes a strain on the relationship. Held says discussing the issue is crucial because:

“Almost all men have erectile dysfunction at some point... it’s how they deal with it that counts.”

Sex therapy can be an effective solution for couples whose relationship is suffering as a result of erectile dysfunction. A qualified therapist can help couples talk through the issues that have arisen, as well as help them identify and work through the psychological reasons that are causing it in the first place.

There is a plethora of medications that can help against erectile dysfunction. Perhaps the most famous one is Viagra, but there are now many more that work better for different patients. In any case, sufferers should discuss the issue with their doctors to determine if and which medication is appropriate for their case.

For some help in responding when ED's been countered, see our blog post, "He's Got His Groove Back. O Happy Day?"

Male Menopause: Stand by Your Man

Admit it, ladies. When it comes to menopause, we’ve sucked up all the oxygen in the room. We’ve cornered the market on attention, research, and therapies. So when men exhibit hormonal symptoms, such as decreased libido, confusion, irritability, fatigue, and insomnia, we chalk it up to a “midlife crisis,” wait for the red convertible, and hope it doesn’t include the 20-something girlfriend.

Many men experience male menopause (or andropause), and all men lose hormones as they age, albeit more gradually than women but with similar effects. Men’s testosterone levels decrease by about one percent per year after age 30. By age 70, testosterone levels are about half what they were at their peak. Even in younger men—in their 40s, 50s, and 60s—the effects of low testosterone can result in mood swings and problems with libido and with maintaining an erection. For most men, this is a severe blow to self-esteem, and it often becomes the pink elephant in the bedroom—denied and overlooked only with very selective vision.

During this life passage, our support is a critical factor in how well our men weather it. “Without an understanding partner, these problems may result in a powerful combination of anxieties and doubts, which can lead to total impotence and sexual frustration,” write Drs. Caroline and Andrew Dott on their website. And if our man is having problems with libido and mood swings, guess what? Our sex life just went south as well.

The reality of male menopause and how best to treat it is still frontier territory—a lot is unknown and a lot of discussion is ongoing. Hormone replacement therapy for men, while promising, is still in need of long-term research. However, for men without underlying emotional or physical problems, testosterone therapy may help reverse the more distressing symptoms of andropause.

As with women, however, the first task is to eliminate any underlying physical or emotional condition that could contribute to loss of libido, impotence, and the symptoms of male menopause. Whatever a man’s testosterone level, if he is obese, if he drinks or smokes or is inactive, his sexual performance will be affected. Smoking and drinking can actually damage, sometimes irreversibly, the nerves and blood vessels in the penis. Certain medications can also affect sexual performance.

The good news is that sexual performance is strongly linked to good overall health for both men and women. Men who are active and who exercise regularly report greater sexual satisfaction than inactive men. So in the course of helping your partner through this phase, you may both gain a healthier lifestyle.

During this challenging time of change and adjustment, it’s important to be aware that your partner could be experiencing many of the same hormonal changes that you are and that your understanding and support is critical. Consider:

  • Educating yourself. Broaching the subject of the physical and emotional changes you’re noticing in your mate is a very touchy subject. Read books like Surviving Male Menopause: A Guide for Women and for Men by Jed Diamond.
  • Breaking the silence gently. Encourage your partner to talk to a doctor or counselor, but expect resistance. It will take time for him to process and acknowledge the very uncomfortable changes he’s experiencing. Denying that there is a problem doesn’t make it go away.
  • Changing the family diet. If you haven’t already, now is the time to adopt the healthful eating habits that will serve both you and your partner well during these transitional years and beyond: low fat, lots of fresh fruits and vegetables, whole grains… you’ve heard it all before.
  • Modeling healthy habits. You can’t steamroll your partner into self-improvement, but if you set the example by working out regularly and not smoking and drinking, maybe your partner will decide to join in. If nothing else, at least you’ll feel better.

He’s Got His Groove Back. O Happy Day?

It’s been a long time since your partner’s been able to “get it up.” And truth be told, you’d grown accustomed to a platonic relationship. You haven’t missed the sex. Frankly, it was never all that great, anyway.

Now, thanks to the marvels of medical science, your man’s erectile dysfunction is a thing of the past. In fact, he may be more “vigorous” now than ever before—and more eager to test his newfound prowess. Which certainly presents you with a challenge. And some choices.

You can roll your eyes and sigh. You can respond in a way that communicates indifference or irritation and that perpetuates the status quo. And, indeed, if the lack of intimacy in your relationship reflects problems with trust or resentment, suddenly regaining the ability to have sex won’t mend the relationship—or make sex any more appealing.

But you could also analyze the reason for your mixed feelings. Maybe your lack of interest stems from remembering a former boring sexual rut. In all likelihood, you’re experiencing physical changes of your own that make it harder to respond to your partner’s new emotional and physical demands. Or maybe your own passivity contributed to the lackluster sex—you always took the passenger seat, never the driver’s seat.

But could it also be possible that your partner’s new ability could be the catalyst for a renaissance of romance in your golden years? For an unexpected reawakening of desire and intimacy? Stranger things have happened.

Embracing this new situation enthusiastically needs to take place at two levels: first, rekindling the emotional connection in the relationship and second, fine-tuning your body to be a sexual creature again. For women, sexual desire and arousal is part of a complex brew of intellectual belief and emotional feelings about yourself, your partner, and sex in general. You need to feel emotionally connected to your partner in order to respond well sexually. For men, it’s just the opposite: It’s the sex that creates intimacy.

Working on the intimacy that can rekindle desire can be as pleasurable and easy as spending time together, lingering over coffee in the morning, taking a walk, holding hands. Remember the romance? Even if you don’t, it isn’t too late to learn.

Second, you’ll need to recondition your body, especially if you’re dealing with menopausal changes. Consider yourself an athlete in training. Regular use of vaginal moisturizers may improve the overall health and condition of your vagina. Don’t overlook the use of lubricants during sex, which not only improve comfort, but can also make intercourse more exciting. You might benefit from a regimen of vaginal dilators to improve your “vaginal capacity.” Talk with your doctor about using a topical estrogen product in your vagina, which can improve elasticity and lubrication, or your doctor might recommend testosterone therapy to boost your libido. In fact, talk to your doctor about any sexual issue that arises; it’s his or her job to have resources to help.

While you’re working on rekindling intimacy and rebuilding your sexual muscle tone, you can also take an active role rebuilding your reinvigorated sex life. It’s too easy to write off sex as a nuisance when you haven’t done anything to change the script. You now have a second chance and the maturity to create the sex life you always wanted as a full and equal partner. Experiment. Play. Communicate.

In the end, your partner’s newfound prowess could be a catalyst for reenergizing your relationship and for rekindling passion. The process may be uncomfortable; it may be a little scary, even; and it will definitely take work. But doesn’t anything worthwhile?

Maintaining Intimacy after Prostate Cancer

Our last post talked about the side effects of prostate cancer treatments for your partner, including loss of libido and erectile dysfunction, and the fact that both of you are affected. While these problems can be devastating to couples who have always enjoyed a healthy sex life, it doesn’t have to mean it’s all over. The important thing is to work together to find solutions that work.

I recommend three steps that happen to start with E: educate, explore, and experiment.

First, educate yourselves about the range of solutions available that might help with the physical limitations you’re now living with, including drugs such as Cialis, Viagra, and Levitra. Penile implants also have a good success rate. While that procedure may be expensive, insurance will often cover some of the costs. Penile injections are also worth considering.

There’s a lot of information online about these solutions, and several books, too, such as Saving Your Sex Life: A Guide for Men with Prostate Cancer, by Dr. John Mulhall.  Your spouse’s urologist should be able to help, too.  Set aside some time just to investigate what’s out there and what might work for you.

You might also want to consider going to a sex therapist, who can help you in your next phase: exploration. If the above solutions don’t appeal to you, or don’t work for one reason or another, start exploring other ways to satisfy your sexual appetites given your new limitations. A sex therapist is trained to offer guidance and may have suggestions you hadn’t thought of. Even if you do decide to try some of the above solutions, a sex therapist can be a tremendous help and a valuable resource. (Visit the American Association of Sex Educators, Counselors, and Therapists website for references.)

As for experimenting, if you’ve never tried a vibrator, this might be the time to start.  And yes, your partner can be part of the enjoyment. In fact, there’s a wonderful column about this by journalist Michael Castleman, who has written about sexuality for 36 years. He wrote a post called, “Gentlemen, Let's Welcome Vibrators Into Partner Sex,” in which he says, “vibrators are as natural as music or candle light…” as he encourages men to experiment with their partners' favorite sex aids.

Of course, oral sex is another option as is mutual hand stimulation. Again, this is the time to experiment and look for alternative ways that are satisfying when penetrative sex is no longer possible. It can actually be very freeing and exciting to experiment. In fact, some couples find they become even closer after they can no longer have “normal” sex.

Remember, too, that cuddling, caressing, and kissing all go a long way to maintaining intimacy. The important thing is to work together to find solutions and not let these physical constraints negatively affect your emotional connection.

Prostate Cancer's Impact on You

Many women at this stage of life, as well as facing some changes of their own, are dealing with the very tough challenges that come when a husband has prostate cancer. Maybe you’re one of them or know someone who is. Although prostate cancer is very treatable today, it’s still terribly scary.

And if that weren’t difficult enough, along with it may come some major issues regarding a man’s sexual performance, adding even more stress and worry to the situation. Some possible side effects of surgery and/or other prostate treatments include challenges to:

  • The ability to get an erection (erectile dysfunction)
  • The desire to have sex
  • The ability to ejaculate and have an orgasm

This affects men not only physically, but emotionally, too, since men’s feelings of masculinity are often tied to their sexual performance.

And as you probably know, men are not always good at talking about sensitive subjects like this. So they often don’t delve too deeply into these side effects, even with their doctors. Or they may be so distraught about the cancer itself, that it just doesn’t seem important at the time.

But it is important. And that’s where you can help. Communicating about it is the first step to dealing with prostate cancer and its impact on your lives. In fact, prostate cancer is often called the “couples disease” because of its broad-reaching effects in the bedroom—and elsewhere.

So while these side effects may be extremely difficult for your partner to deal with, they obviously affect you, too, especially if you have had an active and satisfying sex life. It can be a devastating loss to you both.

That’s why it’s critical to discuss it. Once you’ve begun living with this type of cancer, you need to acknowledge its impact on your relationship. The good news is, there are lots of ways to maintain sexual intimacy after prostate cancer. So instead of looking at it as the end of your sex life, look at it as a new beginning. (I’ll talk about some solutions in our next post.)

It might also be a good idea to find and join a support group so you can talk with other couples about how they are dealing with this issue. I’m a big believer in sharing ideas, which I always encourage readers to do!

If you’ve had experience with prostate cancer (or similar issues) and have advice to offer others—or if you just want to share your thoughts—please add your comment.

Satisfaction: It Works Both Ways

I saw a patient this week who is in her early 60s, in great shape, and happily married to an attractive and generally healthy man also in his 60s. Recently retired from executive positions, they have been traveling to exotic -- and romantic! -- locales, enjoying fine cuisine and luxury accommodations.

They haven’t had sex in two years.

My patient told me that her husband had started having problems maintaining an erection since beginning medication for hypertension. After a series of failed attempts at their usual way of making love, they had given up trying to have intercourse. When I asked her if they pleasured each other sexually in other ways, using oral or manual stimulation for example, she simply shook her head.

This female response to male erectile dysfunction -- not an unusual one by any means -- intrigues me.

When the female half of an otherwise healthy, happy, heterosexual couple experiences a condition that prohibits penetration, she is typically eager to explore other options for sexual intimacy. But it doesn’t seem to work the other way. It’s like if he’s not going to get the ultimate end result -- orgasm -- then neither of them are.

I suspect what happens is that when men have difficulty performing, they start initiating sex less often. So once a week becomes once a month, and then there’s a problem and three months go by and it doesn’t work that time either, and -- then it’s done!

What’s up with that, girls? Do partners with erectile dysfunction really lose all interest in any type of sexual intimacy? Or is it just hard  -- for both of you -- to change the game plan, the way sex happens, the way it starts, the way the “end result” is achieved or defined?

My guess is that many of these men would welcome their partners’ attempts to change things up, to experiment with new techniques and sensual aids that can enhance pleasure on both sides.

What’s your experience? What have you tried? What has worked -- or not? Other women would love to learn from you!