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
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.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Reproductive Health Open Access 27 April 2022
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
Fabbri, A., Caprio, M. & Aversa, A. Pathology of erection. J. Endocrinol. Invest. 26, S87–S90 (2003).
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).
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).
Aghighi, A., Grigoryan, V. H. & Delavar, A. Psychological determinants of erectile dysfunction among middle-aged men. Int. J. Impot. Res. 27, 63–68 (2015).
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).
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).
Goldstein, I. et al. Oral sildenafil in the treatment of erectile dysfunction. N. Engl. J. Med. 338, 1397–1404 (1998).
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).
Kubin, M., Wagner, G. & Fugl-Meyer, A. R. Epidemiology of erectile dysfunction. Int. J. Impot. Res. 15, 63–71 (2003).
Salonia, A. et al. Patient-partner satisfaction of sildenafil treatment in evidence-based organic erectile dysfunction. J. Urol. 161 (Suppl. 4), 213 (1999).
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).
Dorey, G. Partners' perspective of erectile dysfunction: literature review. Br. J. Nurs. 10, 187–195 (2001).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edn (American Psychiatric Association, 2013).
European Association of Urology. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur. Urol. 57, 804–814 (2010).
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).
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).
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).
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).
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).
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).
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).
Renshaw, D. Coping with an impotent husband. Ill. Med. J. 159, 29–33 (1981).
DiMeo, P. J. Psychosocial and relationship issues in men with erectile dysfunction. Urol. Nurs. 26, 442–446 (2006).
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).
Roy, J. & Allen, P. Erectile dysfunction counselling and advice. Pract. Nurs. 27, 46–50 (2004).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
Tomlinson, J. & Wright, D. Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study. BMJ 328, 1037–1040 (2004).
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).
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).
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).
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).
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).
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).
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).
Byun, J. S. et al. Sexual dysfunctions induced by stress of timed intercourse and medical treatment. BJU Int. 111, e227–e234 (2013).
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).
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).
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).
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).
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).
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).
Brock, G. et al. The treatment of erectile dysfunction study: focus on treatment satisfaction of patients and partners. BJU Int. 99, 376–382 (2007).
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).
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).
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).
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).
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).
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).
Schover, L. R. et al. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl. 12, 1–53 (2014).
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).
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).
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).
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).
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).
Leuillet, P., Cour, F. & Droupy, S. Male sexual dysfunctions and homosexuality. Prog. Urol. 23, 727–733 (2013).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
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).
The authors declare no competing financial interests.
About this article
Cite this article
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
This article is cited by
Reproductive Health (2022)