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The role of the sexual partner in managing erectile dysfunction

Key Points

  • Erectile dysfunction (ED) is a common sexual health problem affecting >150 million men worldwide

  • ED is a shared sexual disorder for both the men with ED and their sexual partners, but this fact is not well understood by affected couples or treating physicians

  • The relationship between the patient with ED and his sexual partner should be comprehensively assessed

  • Lack of active involvement of the partner in current medical treatment might contribute to a low recovery from, and unsatisfactory rehabilitation of ED

  • An indispensable role for the sexual partner exists in the assessment of, diagnosis, education, counselling, and choice of therapy for ED

  • The sexual-partner-engaged approach might assist couples affected by ED to achieve a high-quality sex life and social life

Abstract

Erectile dysfunction (ED) has detrimental social and psychological effects on the quality of life of affected individuals and their sexual partners. When medical intervention is introduced to treat ED, physicians, nurses, and clinical educators should consider this disorder as a shared health problem for the men with ED and their sexual partners. New therapeutics such as phosphodiesterase-5 inhibitors improve erectile function in affected men, and the ultimate goal of medical intervention for ED should be achievement of a satisfactory sex life for couples engaged sexual relationships. Sexual partners of men with ED have an important role in its management and improvement in quality of sex life; therefore, they should be involved in assessment of, diagnosis, education, counselling, and choice of therapy. This sexual- partner-engaged approach might assist treatment and rehabilitation, helping the couples affected by ED to achieve a high-quality sex life.

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Figure 1: The sexual-partner-engaged approach for the treatment and rehabilitation of patients with erectile dysfunction (ED).

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References

  1. Fabbri, A., Caprio, M. & Aversa, A. Pathology of erection. J. Endocrinol. Invest. 26, S87–S90 (2003).

    Google Scholar 

  2. Bellamy, G., Gott, M. & Hinchliff, S. Women's understandings of sexual problems: findings from an in-depth interview study. J. Clin. Nurs. 22, 3240–3248 (2013).

    PubMed  Google Scholar 

  3. Chou, P. S. et al. Newly diagnosed erectile dysfunction and risk of depression: a population-based 5-year follow-up study in Taiwan. J. Sex. Med. 128, 804–812 (2015).

    Google Scholar 

  4. Aghighi, A., Grigoryan, V. H. & Delavar, A. Psychological determinants of erectile dysfunction among middle-aged men. Int. J. Impot. Res. 27, 63–68 (2015).

    CAS  PubMed  Google Scholar 

  5. Cobo Cuenca, A. I., Sampietro-Crespo, A., Virseda-Chamorro, M. & Martín-Espinosa, N. Psychological impact and sexual dysfunction in men with and without spinal cord injury. J. Sex. Med. 124, 436–444 (2015).

    Google Scholar 

  6. Mo, M. Q. et al. Sexual dysfunctions and psychological disorders associated with type IIIa chronic prostatitis: a clinical survey in China. Int. Urol. Nephrol. 4622, 2255–2261 (2014).

    Google Scholar 

  7. Goldstein, I. et al. Oral sildenafil in the treatment of erectile dysfunction. N. Engl. J. Med. 338, 1397–1404 (1998).

    CAS  PubMed  Google Scholar 

  8. Carvalheira, A. A., Pereira, N. M., Maroco, J. & Forjaz, V. Dropout in the treatment of erectile dysfunction with PDE5: a study on predictors and a qualitative analysis of reasons for discontinuation. J. Sex. Med. 9, 2361–2369 (2012).

    PubMed  Google Scholar 

  9. Kubin, M., Wagner, G. & Fugl-Meyer, A. R. Epidemiology of erectile dysfunction. Int. J. Impot. Res. 15, 63–71 (2003).

    CAS  PubMed  Google Scholar 

  10. Salonia, A. et al. Patient-partner satisfaction of sildenafil treatment in evidence-based organic erectile dysfunction. J. Urol. 161 (Suppl. 4), 213 (1999).

    Google Scholar 

  11. Jiann, B. P., Su, C. C. & Tsai, J. Y. Is female sexual function related to the male partners' erectile function? J. Sex. Med. 10, 420–429 (2013).

    PubMed  Google Scholar 

  12. Dorey, G. Partners' perspective of erectile dysfunction: literature review. Br. J. Nurs. 10, 187–195 (2001).

    CAS  PubMed  Google Scholar 

  13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edn (American Psychiatric Association, 2013).

  14. European Association of Urology. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur. Urol. 57, 804–814 (2010).

  15. Fisher, W. A. et al. Communication about erectile dysfunction among men with ED, partners of men with ED, and physicians: the Strike Up a Conversation Study (Part I). J. Mens Health Gend. 2, 64–78 (2005).

    Google Scholar 

  16. Fisher, W. A., Meryn, S., Sand, M. & The Strike Up a Conversation Study Team. Communication about erectile dysfunction among men with ED, partners of men with ED, and physicians: The Strike Up a Conversation Study (Part II). J. Mens Health Gend. 2, 309.e1–309.e12 (2005).

    Google Scholar 

  17. Fisher, W. A., Eardley, I., McCabe, M. & Sand, M. Erectile dysfunction (ED) is a shared sexual concern of couples I: couple conceptions of ED. J. Sex. Med. 6, 2746–2760 (2009).

    PubMed  Google Scholar 

  18. Riley, A. & Riley, E. Behavioural and clinical findings in couples where the man presents with erectile disorder: a retrospective study. Int. J. Clin. Pract. 54, 220–224 (2000).

    CAS  PubMed  Google Scholar 

  19. Fisher, W. A., Rosen, R. C., Eardley, I., Sand, M., & Goldstein, I. Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study. J. Sex. Med. 2, 675–684 (2005).

    PubMed  Google Scholar 

  20. Greenstein, A., Abramov, L., Matzkin, H. & Chen, J. Sexual dysfunction in women partners of men with erectile dysfunction. Int. J. Impot. Res. 18, 44–46 (2006).

    CAS  PubMed  Google Scholar 

  21. Yiou, R., Ebrahiminia, V., Mouracade, P., Lingombet, O. & Abbou, C. Sexual quality of life in women partnered with men using intracavernous alprostadil injections after radical prostatectomy. J. Sex. Med. 10, 1355–1362 (2013).

    PubMed  Google Scholar 

  22. Renshaw, D. Coping with an impotent husband. Ill. Med. J. 159, 29–33 (1981).

    CAS  Google Scholar 

  23. DiMeo, P. J. Psychosocial and relationship issues in men with erectile dysfunction. Urol. Nurs. 26, 442–446 (2006).

    PubMed  Google Scholar 

  24. Chevret, M., Jaudinot, E., Sullivan, K., Marrel, A. & De Gendre, A. S. Impact of erectile dysfunction (ED) on sexual life of female partners: assessment with the Index of Sexual Life (ISL) questionnaire. J. Sex Marital Ther. 30, 157–172 (2004).

    PubMed  Google Scholar 

  25. Roy, J. & Allen, P. Erectile dysfunction counselling and advice. Pract. Nurs. 27, 46–50 (2004).

    Google Scholar 

  26. O'Connor, E. J., McCabe, M. P., Conaglen, H. M. & Conaglen, J. P. Attitudes and experiences: qualitative perspectives on erectile dysfunction from the female partner. J. Health Psychol. 17, 3–13 (2012).

    PubMed  Google Scholar 

  27. Chedraui, P. et al. Severe menopausal symptoms in middle-aged women are associated to female and male factors. Arch. Gynecol. Obstet. 281, 879–885 (2010).

    PubMed  Google Scholar 

  28. Ma, J., Pan, L., Lei, Y., Zhang, A. & Kan, Y. Prevalence of female sexual dysfunction in urban Chinese women based on cutoff scores of the Chinese version of the female sexual function index: a preliminary study. J. Sex. Med. 11, 909–919 (2014).

    PubMed  Google Scholar 

  29. Zhang, H. & Yip, P. S. Female sexual dysfunction among young and middle-aged women in Hong Kong: prevalence and risk factors. J. Sex. Med. 9, 2911–2918 (2012).

    PubMed  Google Scholar 

  30. Shaeer, O., Shaeer, K. & Shaeer, E. The Global Online Sexuality Survey (GOSS): female sexual dysfunction among Internet users in the reproductive age group in the Middle East. J. Sex. Med. 9, 411–424 (2012).

    PubMed  Google Scholar 

  31. Speckens, A. E., Hengeveld, M. W., Lycklama à Nijeholt, G., van Hemert, A. M. & Hawton, K. E. Psychosexual functioning of partners of men with presumed non-organic erectile dysfunction: cause or consequence of the disorder? Arch. Sex. Behav. 24, 157–172 (1995).

    CAS  PubMed  Google Scholar 

  32. Nappi, R. E., Kingsberg, S., Maamari, R. & Simon, J. The CLOSER (CLarifying Vaginal Atrophy's Impact On Sex and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J. Sex. Med. 10, 2232–2241 (2013).

    PubMed  Google Scholar 

  33. Meuleman, E. J., Hatzichristou, D., Rosen, R. C. & Sadovsky, R. Diagnostic tests for male erectile dysfunction revisited. Committee Consensus Report of the International Consultation in Sexual Medicine. J. Sex. Med. 7, 2375–2381 (2010).

    PubMed  Google Scholar 

  34. Burd, I. D., Nevadunsky, N. & Bachmann, G. Impact of physician gender on sexual history taking in a multispecialty practice. J. Sex. Med. 3, 194–200 (2006).

    PubMed  Google Scholar 

  35. Athanasiadis, L. et al. Educating physicians to treat erectile dysfunction patients: development and evaluation of a course on communication and management strategies. J. Sex. Med. 3, 47–55 (2006).

    PubMed  Google Scholar 

  36. Wittmann, D. et al. Exploring the role of the partner in couples' sexual recovery after surgery for prostate cancer. Support Care Cancer 22, 2509–2515 (2014).

    PubMed  Google Scholar 

  37. Tomlinson, J. & Wright, D. Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study. BMJ 328, 1037–1040 (2004).

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Lording, D. W. et al. Partners of affected men; attitudes to erectile dysfunction. Proceedings of the 7th Biennial Asia-Pacific Meeting on Impotence 1999, Tokyo Japan. Int. J. Import Res. 12, S16 (2000).

    Google Scholar 

  39. Chevret-Méasson, M. et al. Improvement in quality of sexual life in female partners of men with erectile dysfunction treated with sildenafil citrate: findings of the Index of Sexual Life (ISL) in a couple study. J. Sex. Med. 6, 761–769 (2009).

    PubMed  Google Scholar 

  40. Fisher, W. A., Eardley, I., McCabe, M. & Sand, M. Erectile dysfunction (ED) is a shared sexual concern of couples II: association of female partner characteristics with male partner ED treatment seeking and phosphodiesterase type 5 inhibitor utilization. J. Sex. Med. 6, 3111–3124 (2009).

    PubMed  Google Scholar 

  41. Derogatis, L. R., Meyer, J. K. & Gallant, B. W. Distinctions between male and female invested partners in sexual disorders. Am. J. Psychiatry 134, 385–390 (1977).

    CAS  PubMed  Google Scholar 

  42. Dean, J. et al. Integrating partners into erectile dysfunction treatment: improving the sexual experience for the couple. Int. J. Clin. Pract. 62, 127–133 (2008).

    CAS  PubMed  Google Scholar 

  43. Carroll, J. L. & Bagley, D. H. Evaluation of sexual satisfaction in partners of men experiencing erectile failure. J. Sex Marital Ther. 16, 70–78 (1990).

    CAS  PubMed  Google Scholar 

  44. Conaglen, H. M. & Conaglen, J. V. Couples' reasons for adherence to, or discontinuation of, PDE type 5 inhibitors for men with erectile dysfunction at 12 to 24-month follow-up after a 6-month free trial. J. Sex. Med. 9, 857–865 (2012).

    PubMed  Google Scholar 

  45. Byun, J. S. et al. Sexual dysfunctions induced by stress of timed intercourse and medical treatment. BJU Int. 111, e227–e234 (2013).

    PubMed  Google Scholar 

  46. Brock, G. B. et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J. Urol. 168, 1332–1336 (2002).

    CAS  PubMed  Google Scholar 

  47. Bai, W. J. et al. An open-label, multicenter, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in Chinese men naïve to phosphodiesterase 5 inhibitor therapy. Asian J. Androl. 17, 61–67 (2015).

    CAS  PubMed  Google Scholar 

  48. Li, H. J. et al. An analysis of treatment preferences and sexual quality of life outcomes in female partners of Chinese men with erectile dysfunction. Asian J. Androl. http://dx.doi.org/10.4103/1008-682X.159719 (2015).

  49. Conaglen, H. M. & Conaglen, J. V. Investigating women's preference for sildenafil or tadalafil use by their partners with erectile dysfunction: the partners' preference study. J. Sex. Med. 5, 1198–1207 (2008).

    PubMed  Google Scholar 

  50. Lee, J. et al. Physician-rated patient preference and patient- and partner-rated preference for tadalafil or sildenafil citrate: results from the Canadian 'Treatment of Erectile Dysfunction' observational study. BJU Int. 98, 623–629 (2006).

    CAS  PubMed  Google Scholar 

  51. Dean, J. et al. Psychosocial outcomes and drug attributes affecting treatment choice in men receiving sildenafil citrate and tadalafil for the treatment of erectile dysfunction: results of a multicenter, randomized, open-label, crossover study. J. Sex. Med. 3, 650–661 (2006).

    CAS  PubMed  Google Scholar 

  52. Brock, G. et al. The treatment of erectile dysfunction study: focus on treatment satisfaction of patients and partners. BJU Int. 99, 376–382 (2007).

    CAS  PubMed  Google Scholar 

  53. Cameron, A., Rosen, R. C. & Swindle, R. W. Sexual and relationship characteristics among an internet-based sample of U.S. men with and without erectile dysfunction. J. Sex Marital Ther. 31, 229–242 (2005).

    PubMed  Google Scholar 

  54. Huang, S. T. & Jiann, B. P. Assessing satisfaction in men and their female partners after treatment with phosphodiesterase type 5 inhibitors for erectile dysfunction. Int. J. Impot. Res. 25, 178–182 (2013).

    CAS  PubMed  Google Scholar 

  55. Goldstein, I. et al. Women's sexual function improves when partners are administered vardenafil for erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial. J. Sex. Med. 2, 819–832 (2005).

    CAS  PubMed  Google Scholar 

  56. Zaider, T., Manne, S., Nelson, C., Mulhall, J. & Kissane, D. Loss of masculine identity, marital affection, and sexual bother in men with localized prostate cancer. J. Sex. Med. 9, 2724–2732 (2012).

    PubMed  PubMed Central  Google Scholar 

  57. White, I. D. et al. Development of UK guidance on the management of erectile dysfunction resulting from radical radiotherapy and androgen deprivation therapy for prostate cancer. Int. J. Clin. Pract. 69, 106–123 (2015).

    CAS  PubMed  Google Scholar 

  58. Walker, L. M., Wassersug, R. J. & Robinson, J. W. Psychosocial perspectives on sexual recovery after prostate cancer treatment. Nat. Rev. Urol. 121, 7–76 (2015).

    Google Scholar 

  59. Schover, L. R. et al. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl. 12, 1–53 (2014).

    Google Scholar 

  60. Hampton, A. J., Walker, L. M., Beck, A. & Robinson, J. W. A brief couples' workshop for improving sexual experiences after prostate cancer treatment: a feasibility study. Support Care Cancer 21, 3403–3409 (2013).

    PubMed  Google Scholar 

  61. Walker, L. M., Hampton, A. J., Wassersug, R. J., Thomas, B. C. & Robinson, J. W. Androgen deprivation therapy and maintenance of intimacy: a randomized controlled pilot study of an educational intervention for patients and their partners. Contemp. Clin. Trials 34, 227–231 (2013).

    PubMed  Google Scholar 

  62. Chambers, S. K. et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology 24, 748–756 (2015).

    PubMed  Google Scholar 

  63. Elliott, S. et al. Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life. J. Sex. Med. 7, 2996–3010 (2010).

    CAS  PubMed  Google Scholar 

  64. Lau, J. T., Kim, J. H. & Tsui, H. Y. Prevalence and sociocultural predictors of sexual dysfunction among Chinese men who have sex with men in Hong Kong. J. Sex. Med. 5, 2766–2779 (2008).

    PubMed  Google Scholar 

  65. Leuillet, P., Cour, F. & Droupy, S. Male sexual dysfunctions and homosexuality. Prog. Urol. 23, 727–733 (2013).

    CAS  PubMed  Google Scholar 

  66. Shindel, A. W., Vittinghoff, E. & Breyer, B. N. Erectile dysfunction and premature ejaculation in men who have sex with men. J. Sex. Med. 9, 576–584 (2012).

    PubMed  PubMed Central  Google Scholar 

  67. Hirshfield, S. et al. Sexual dysfunction in an Internet sample of U.S. men who have sex with men. J. Sex. Med. 7, 3104–3114 (2010).

    PubMed  PubMed Central  Google Scholar 

  68. Vansintejan, J., Janssen, J., Van De Vijver, E., Vandevoorde, J. & Devroey, D. The Gay Men Sex Studies: prevalence of sexual dysfunctions in Belgian HIV+ gay men. HIV AIDS (Auckl.) 5, 89–96 (2013).

    Google Scholar 

  69. Mao, L. et al. Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia. J. Sex. Med. 6, 1378–1385 (2009).

    PubMed  Google Scholar 

  70. Shindel, A. W., Horberg, M. A., Smith, J. F. & Breyer, B. N. Sexual dysfunction HIV and AIDS in men who have sex with men. AIDS Patient Care STDS 25, 341–349 (2011).

    PubMed  PubMed Central  Google Scholar 

  71. Hart, T. A. et al. The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men. J. Sex. Med. 9, 1106–1113 (2012).

    PubMed  PubMed Central  Google Scholar 

  72. Kelly, B. C. & Parsons, J. T. Prevalence and predictors of non-medical prescription drug use among men who have sex with men. Addict. Behav. 35, 312–317 (2010).

    PubMed  Google Scholar 

  73. Lamba, H., Goldmeier, D., Mackie, N. E., Scullard, G. Antiretroviral therapy is associated with sexual dysfunction and with increased serum oestradiol levels in men. Int. J. STD AIDS 15, 234–237 (2004).

    PubMed  Google Scholar 

  74. Tsui, H. Y. et al. Sexual dysfunction and unprotected anal intercourse among men who have sex with men in two Chinese cities. J. Sex Marital Ther. 40, 139–148 (2014).

    PubMed  Google Scholar 

  75. Meng, X. et al. Relative risk for HIV infection among men who have sex with men engaging in different roles in anal sex: a systematic review and meta-analysis on global data. AIDS Behav. 19, 882–889 (2015).

    PubMed  Google Scholar 

  76. Vansintejan, J., Vandevoorde, J. & Devroey, D. The GAy MEn Sex StudieS: erectile dysfunction among Belgian gay men. Int. J. Gen. Med. 6, 527–534 (2013).

    PubMed  PubMed Central  Google Scholar 

  77. Daskalopoulou, M. et al. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV 1, e22–e31 (2014).

    PubMed  Google Scholar 

  78. Nettles, C. D., Benotsch, E. G., Uban, K. A. Sexual risk behaviors among men who have sex with men using erectile dysfunction medications. AIDS Patient Care STDS 23, 1017–1023 (2009).

    PubMed  Google Scholar 

  79. Ramchand, R., Fisher, M. P., Griffin, B. A., Becker, K. & Iguchi, M. Y. Drug use among gay and bisexual men at weekend dance parties: the role of intentions and perceptions of peers' behaviors. AIDS Behav. 17, 1540–1549 (2013).

    PubMed  PubMed Central  Google Scholar 

  80. Benotsch, E. G. et al. Substance use, medications for sexual facilitation, and sexual risk behavior among traveling men who have sex with men. Sex. Transm. Dis. 337, 6–711 (2006).

    Google Scholar 

  81. Prestage, G. et al. Australian gay and bisexual men's use of erectile dysfunction medications during recent sexual encounters. J. Sex. Med. 11, 809–819 (2014).

    PubMed  Google Scholar 

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H.-J. L. researched data for and edited the article before submission, H.-J. L. and T. G. wrote the article, and H.-J. L., T. G. and R. W. discussed content, for the article.

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Correspondence to Hongjun Li.

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Li, H., Gao, T. & Wang, R. The role of the sexual partner in managing erectile dysfunction. Nat Rev Urol 13, 168–177 (2016). https://doi.org/10.1038/nrurol.2015.315

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