Advice for women on how to cope with their partner's erectile dysfunction.
Brunilda Nazario, MD
The TV commercials make it all seem so simple: He can't get an erection so he pops a pill. The next thing you know, his partner is cooing about how her guy is back to his old wild and romantic self.
What the commercials don't show you: The painful distress a woman can experience when her man suffers with erectile dysfunction (ED).
"Women internalize things -- they tend to blame themselves first, thinking it's because they have done something wrong, or that they are no longer attractive to their partner. In fact, the first thing a woman thinks when a man can't get an erection is that it's her fault, and nothing could be further from the truth," says Andrew McCullough, MD, director of sexual health and male infertility at NYU Medical Center in New York City.
ED, or erectile dysfunction, is medically defined as the inability to achieve or sustain an erection long enough for sexual intercourse. Virtually all men experience some erection failures at certain points in their lives. It can be the result of stress, depression, or sometimes even for no reason at all. For some, the problem becomes chronic. When it does, a diagnosis of ED is made. According to the American Foundation for Urologic Disease, it's a problem that affects about 18 million men in the U.S. alone.
Although many women -- and men as well -- continue to view ED as a sexual issue, in truth, the most common causes are undiagnosed physical conditions such as diabetes, high cholesterol, or even the earliest stages of heart disease. Even more often, it can be the result of certain medications used to treat these conditions, particularly some high blood pressure drugs.
Unfortunately, experts say a lack of education about the causes of ED are frequently behind a woman's self-blame, as well as her increasing anxiety, and sometimes, even feelings of hurt and anger when the problem occurs.
"Most women usually start with a line of questioning that often has some anxiety or hurt to it. She may suspect her partner is having an affair, or that he just doesn't find her desirable anymore, so she begins to hint around at these possibilities," says Sallie Foley, MSW, a professor at the graduate school of social work at the University of Michigan and co-author of Sex Matters For Women.
Often, says Foley, a man suffering with ED will interpret her questions -- and her hurtful attitude -- as an attack on him, so he pulls back.
"She then experiences this pulling back as a confirmation that she has done something wrong, and so she retreats even further," says Foley. As she does, increasing levels of anxiety or depression can set in, along with suspicions about what's going on with him, as well as a continued belief that there is something wrong with her.
The end result: The couple can stop communicating altogether -- not only in the bedroom, but in all aspects of their relationship. And that, say experts, can only make problems worse for both partners.
"The one thing a woman should never do is withdraw because that is a formula for relationship disaster," says McCullough. When one partner pulls away, he says, the other withdraws as well, and "this kind of dance goes on where you stop touching each other, then you stop talking, and before you know it you are not communicating at all."
Women and ED: Striking a Balance
While pulling back may not be helpful, trying harder isn't the answer either. Indeed, while many women jump ship in troubled waters, others take the opposite approach and try to drown their mate in eroticism, believing the problems will disappear if they simply try harder. Not only is this not true, experts say this approach can make things worse.
"If you suddenly start trotting out all your old Victoria's Secret underwear -- or buy some sexy new clothes -- well, that's only going to put more pressure on him, and it's not going to help the ED one bit," says Foley.
Neither, she says, will more arduous attempts at making love. "Stroking him harder isn't going to matter either because you have to remember, this isn't a problem related to being turned on," says Foley. As such, the more and the harder you try, the worse it's going to be for him -- and for you -- when it doesn't happen, says Foley.
McCullough agrees: "You don't want to forget about what's going on, or pretend it doesn't matter, but turning into a nymphomaniac isn't the answer either."
So what should a woman do when her man just can't perform? Experts seem to agree that most important is to remember it's not your problem and you're not the cause.
"Don't feel rejected and don't personalize it. It's not about you," says Foley.
Once you're past that hurdle, experts say do acknowledge the problem exists and open the lines of communication about it.
"The best thing to do is to discuss things outside of the bedroom -- not right after it happens, but days or even weeks later," says sex expert Jennifer Downey, MD, a psychiatrist at New York State Psychiatric Institute and a professor at Columbia University. During this talk, Downey says make certain that your man is aware of the health problems that can be the cause of his ED, and gently suggest he talk to his doctor.
Indeed, Downey believes the more matter of fact a woman can be in approaching this conversation, the more likely she is to get through to her man.
"You have to treat this the way you would any other non-life threatening issues in your relationship, and just calmly discuss it," says Downey.
McCullough adds, "If you put it in the context of a physical problem and not a sexual one, most men will be less likely to 'shut down' or shut you out." While some men would rather go the treatment route alone, others might welcome the support of their partner, so be certain to make the offer to go with him, and then let your man decide.
Also important, say experts, is to use this discussion to let him know that you have enjoyed the physical part of your relationship together, and that you miss it -- and that together you can work to find a solution.
"This is the time to treat your man as your best friend -- to be warm, to be friendly, to grab his hand, to give him hugs and kisses, to let him know that you care about him, that he is desirable, that physical closeness is important," says Foley.
ED: Make It a Time for Sexual Experimentation
Depending on the cause of a man's ED, treatment can be quick, like Viagra, or take longer, like getting high blood pressure under control. It may even take a while to convince him to see a doctor at all.
The one thing you don't want to do in the meantime is tell him that his impotence doesn't matter.
"It matters to him, and saying that you don't care also sends a message that you don't miss the sexual, intimate contact with him -- and that can push a man even further away," says McCullough.
What you want to do instead, say experts, is use this opportunity to experiment sexually with each other and work on ways to remain intimate, even when an erection is not possible.
"There are lots of different ways to be sexual, and if one way becomes difficult or even impossible, you have to explore, together, the things you can do with each other than are sexually exciting," says Downey.
And if, like many women, you are used to your partner being the sexual initiator, this, say experts, may be the time for a little role-reversal.
"It's perfectly OK for a woman to say, 'Until we can find an answer to our problem, I want us to stay in touch physically and intimately,' and then seek his suggestions for how to do that," says Foley.
The key, she says, is in the intentionality. "You have to go into it with the attitude of 'playing,' not fixing your sex life. It's all in the intentionality," Foley tells WebMD.
If, in fact, your man retreats even further, then he may be experiencing depression -- another possible cause for his ED. If this is the case, experts say don't let it throw you.
"If a man says 'no' to you with a lot of irritability, I still wouldn't take it personally or feel rejected, because it's very likely he's suffering some depression -- and again, it's not you," says Foley.
The bottom line: Whatever it takes, experts say don't shut down the line of emotional communication, even if you have to put your physical relationship on hold. And most importantly, listen to your heart.
"If a woman can just manage to not feel personally wounded by ED, if she can get in touch with her kindness, and her intuitive, nurturing side and follow those instincts, she'll very likely know all the right things to do and say to keep that vital communication going and keep the intimacy alive," says Foley.
Published Nov. 8, 2004.
SOURCES: Andrew McCullough, MD, director of sexual health and male infertility, NYU Medical Center; associate professor, NYU School of Medicine, New York. Sallie Foley, MSW, professor, Graduate School of Social Work, University of Michigan; co-author, Sex Matters For Women. Jennifer Downey, MD, clinical professor of psychiatry, Columbia University; psychiatrist and psychoanalyst, New York State Psychiatric Institute, New York. American Foundation for Urologic Disease Sexual Function Advisory Council publication on ED, 2004.
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