Having ‘The Talk’: How to Approach Your Partner About Erectile Dysfunction
Erectile dysfunction (ED), or the inability to get and maintain an erection suitable for penetrative sex, is a common medical condition that has physical and psychological causes that some couples find difficult to discuss. However, not having this conversation only exacerbates the problem by making everyone feel as if they are the only ones dealing with this common medical condition.
A disruption in the sexual response, whether due to ED or another condition, causes considerable distress for men and their partners. Partners of men with ED may feel rejected, concerned, frustrated, or lonely. They may believe that they are unattractive or their partner is uninterested in them and that this is the underlying cause of ED. Blame and anxiety make it difficult to problem-solve.
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Should you talk about ED with your partner?
ED affects people of all ages, including men in their 20s and 30s. Men may feel isolated, and their partners may be unsure about their relationship status. Naturally, people may jump to unwarranted conclusions when emotions and perceptions are involved. Talk to your partner about ED. Doing so may have lifelong psychological and physical benefits.
Why is it so hard to talk about ED?
Up until the 1970s, ED was felt to have purely psychological causes. This was largely an effect of Master’s and Johnson’s influential study that stated that only 5% of ED could be attributed to physical causes, and there was little research on the psychological impact of ED.1,2
Most research has been directed toward identifying potential treatment options and not toward understanding the psychosocial aspects of ED. Differentiating between physical and psychological contributions to ED becomes less relevant as ED has become understood to be a complex medical condition that always involves physical, psychological, and social factors.3
When ED is assumed to be a largely psychological condition, men may feel more uncomfortable discussing it and become defensive, especially if they do not fully understand why they have ED.
What causes ED?
An erection requires a complex interaction between the endocrine, cardiovascular, and nervous systems, which psychological and environmental factors can modify. A breakdown in communication or psychological response between the nervous system, blood flow, nerve transmission, or brain messaging can cause ED.
Many factors contribute to ED, including:3
- An expectation of inadequate sexual performance
- A tendency to evaluate sexual performance, leading to excess sympathetic nervous system stimulation
- Avoidance behavior
- Negative automatic thoughts
- Unrealistic, unattainable, macho-like expectations
- Untreated or under-treated anxiety or depression
- Social stressors
- A lack of adequate sexual stimulation
- Decreased response to sexual stimulation
- A decrease in feedback loops between subjective feelings of arousal and the physical response
- Comorbid medical conditions such as diabetes, heart disease, low testosterone, and high blood pressure or cholesterol
- Vascular or neurologic disease
- Hormonal imbalances
- Medication-induced ED
- Lifestyle factors such as smoking and excessive alcohol consumption
All of these factors can contribute to ED, and anxiety about the cause of ED can actually prevent men from getting an erection.
How do I start a conversation about erectile dysfunction?
Before having this conversation, consider why you want to talk with your partner about ED. Are you concerned that an underlying physical or psychological condition is causing their symptoms? Are you feeling insecure about the relationship? Explore your feelings. It is easy to feel hurt, rejected, or even suspect that your partner is cheating when dealing with sexual concerns.
Think about your partner. Has he made an effort to understand why he has ED? Is a medical evaluation necessary before discussing how ED is affecting your relationship?
All difficult conversations are best handled in an environment where both people are comfortable and receptive to talking, and neither feels they have an advantage. Save the talk for a time when distractions are minimized and emotions are under control. Have your conversation in a non-threatening, non-sexual setting where neither partner has a perceived advantage.
Once you start the conversation, follow through. While you don’t want to pressure your partner into sexual activity, you also do not want to minimize the importance of sex as part of a healthy partner relationship. You can’t fix your partner’s ED, but you can support them as they look for the underlying cause and seek treatment.
Maintain intimacy in your relationship. Sex is an important aspect of intimacy in a relationship, as are other forms of physical touch. Intimacy is a sense of being close, connected, and supported. Emotional and physical intimacy are important and involve sharing your thoughts and feelings with your partner. Being intimate with a partner entails taking risks as you share your thoughts and feelings. However, it is worth the effort because having healthy, intimate relationships is important to overall mental health.
How is ED treated?
Men have many options for treating ED. While many start with phosphodiesterase class-5 (PDE-5) inhibitors, the American Urological Association (AUA) recommends that patients and their physicians choose an ED treatment using a process of shared-decision making. Men should be informed of all treatment options that are not medically contraindicated. While in most cases, the least invasive treatment option is chosen first, the AUA says it is valid for men to begin with any treatment option, regardless of its invasiveness or irreversibility.
Trimix injections are well-tested and a solution for many men with ED. Trimix comprises three medications that synergistically increase blood flow into the penis to help men get and maintain an erection.
Learn more about buying Trimix injections online.
- Tomlinson J, Wright D. Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study. BMJ. 2004 May 1;328(7447):1037. doi: 10.1136/bmj.38044.662176.EE. Epub 2004 Mar 29. PMID: 15051618; PMCID: PMC403839.
- Master WH, Johnson VE. Principles of the new sex therapy. Am J Psychiatry. 1976 May;133(5):548-54. doi: 10.1176/ajp.133.5.548. PMID: 1267060.
- Dewitte M, Bettocchi C, Carvalho J, Corona G, Flink I, Limoncin E, Pascoal P, Reisman Y, Van Lankveld J. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med. 2021 Dec;9(6):100434. doi: 10.1016/j.esxm.2021.100434. Epub 2021 Oct 7. PMID: 34626919; PMCID: PMC8766276.
- Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. J Urol. Sep 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004