What does it mean when a partner loses his erection?
When a partner regularly cannot get or keep an erection firm enough for sex, it is erectile dysfunction, and most cases have more than one cause. Erectile dysfunction affects the quality of life of both partners, so guidelines include the partner in assessment and treatment. Partner satisfaction after implant surgery is reported at 91% to 95%.
What causes erectile dysfunction in a partner?
Most erectile dysfunction has mixed physical and psychological causes. Physical risk factors include age, diabetes, high blood pressure, heart disease, obesity, lack of exercise and smoking, and some medicines, including certain blood pressure medicines and antidepressants, are also linked with it.
Relationship factors play a part too. Dissatisfaction with the partner, a poor sexual relationship, the length of the relationship and feeling emotionally disconnected during sex have all been linked with erectile difficulties, while intimacy was found to protect against erectile dysfunction. Mental health problems such as depression and anxiety are common alongside it.
Why do guidelines involve the partner?
The first step in assessing erectile dysfunction is a detailed medical and sexual history from the man and, when available, his partner. The consultation covers the expectations and needs of both, their understanding of the problem and of any test results, and the reasons for the chosen treatment.
"Relationship factors, including lack of satisfaction with the partner, poor sexual relationships, length of the relationship, or feeling emotionally disconnected from the partner during sex, have been related to erectile difficulties and ED." Source 1, p. 45
Specific tests can be arranged at the request of the man or his partner. Explaining how sexual response works is often the first step in treatment and has been shown to improve sexual satisfaction.
Which treatments involve both partners?
Cognitive behavioural therapy (CBT) is recommended, including in couple format, and the European guideline recommends including the partner when it is indicated, combined with medical treatment. Psychosocial approaches also include marital therapy and psychosexual education.
Because both members of a couple may go through age-related changes at the same time, the European guideline suggests that it can help to address the sexual health of the ageing couple as a whole. If an implant is chosen, the American guideline asks that both the man and his partner are counselled on its benefits, risks and realistic results.
How satisfied are partners with treatment?
With injections of alprostadil into the penis, satisfaction was reported at 87% to 93.5% in patients and 86% to 90.3% in partners. Satisfaction after penile implant surgery is among the highest of any treatment, at 92% to 100% in patients and 91% to 95% in partners, with appropriate counselling.
Counselling aimed at sexual and relationship concerns may also help both the man and his partner after implant surgery. An implant has no direct effect on sex drive, so a loss of desire is assessed separately.
Could erectile dysfunction point to another health problem?
Erectile dysfunction is a risk marker for underlying heart and blood vessel disease and other health conditions that may need assessment and treatment. More severe and longer-standing erectile dysfunction carries a greater risk, and erectile dysfunction can improve screening for heart disease that is not yet causing symptoms.
For this reason the assessment includes blood tests for glucose, blood fats and testosterone, and an estimate of the man's heart risk. Treating these conditions is part of the first step in treating the erectile dysfunction itself.