CIEF - Consortium for Improvement in Erectile Function

Each month, questions with a common theme will be selected and answered comprehensively by our Steering Committee and Distinguished Faculty members. Previously answered questions will be archived each month for your reference. If you wish to submit a question, click here.

To view archived responses, click here.

This Month's Questions:

Erectile dysfunction (ED) affects not only the man with the condition but also his partner and their relationship. What is the impact of ED on the partner, and how can she contribute to successful treatment of the patient’s condition? In addition, how can clinicians begin to treat ED as a condition shared by the couple?

Response by Jacob Rajfer, MD, Posted 12/04/06:

ED is unique in that it is a shared dysfunction: The patient experiences it, but it also negatively affects the sexual function and experience of his partner, as well as their relationship.¹

Many partners of men with ED are likely to experience sexual dysfunction, reporting dissatisfaction in terms of decreased sexual desire and orgasmic problems. These issues, in turn, can have a detrimental impact on treatment success for patients with ED,^2,3 causing a vicious cycle in a couple’s relationship.

The partner of a patient with ED can significantly influence the choice of treatment. To prescribe the treatment that will work best for the patient, clinicians may find it helpful to evaluate the patient’s relationship with his partner and consider any concerns or expectations that she might have with the proposed treatment.¹ Partner dissatisfaction or discomfort with the treatment strategy can lead to patient noncompliance with therapy. Should a couple differ in their expectations for treatment outcome, they are likely to be less satisfied with the results. In addition, if the partner is not cooperative or not interested in the man regaining his capability for sexual intercourse, she can hinder the treatment process,^3,4 which emphasizes the importance of treating the couple as a unit.

The partner interview and discussion of their relationship might clarify which therapeutic agent would work best for the couple.¹ The 3 phosphodiesterase type 5 (PDE5) inhibitors are well established as the first-line therapy for ED. The pharmacokinetic differences between these agents, specifically longer or shorter duration of action, provide couples with choices for treatment. Couples with more defined or planned sexual routines tend to be more comfortable with a shorter-acting agent (sildenafil or vardenafil), whereas those with a pattern of more spontaneous sexual activity or the need for greater flexibility in the timing of sexual relations may prefer the longer-acting agent (tadalafil).¹

In summary, it is important to involve the partners of patients with ED in the assessment and management strategy whenever possible.^1,3 The physical and emotional issues of both the patient and the partner, as well as their dynamic as a couple, should be acknowledged and addressed.^2,5 In doing so, the clinician may optimize treatment of the patient’s ED and improve the overall health and well-being of the patient and his partner.

References

Dunn ME, Althof SE, Perelman MA. Phosphodiesterase type 5 inhibitors’ extended duration of response as a variable in the treatment of erectile dysfunction [review]. Int J Impot Res. 2006 Jun 1; [Epub ahead of print].
Greenstein A, Abramov L, Matzkin H, Chen J. Sexual dysfunction in women partners of men with erectile dysfunction. Int J Impot Res. 2006;18:44-46.
Riley A. The role of the partner in erectile dysfunction and its treatment. Int J Impot Res. 2002;14(suppl 1):S105-S109.
Montorsi F, Althof SE. Partner responses to sildenafil citrate (Viagra) treatment of erectile dysfunction. Urology. 2004;63:762-767.
Shabsigh R, Levy A, Eid JF, Kloner RA, Neuman WR. Voices and choices: physician, patient, and partner perspectives on the management of erectile dysfunction. J Sex Med. 2006;3(suppl 1):4-9.

To view archived responses, click here.