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This Month's Question

Optimal management of erectile dysfunction (ED) requires the partner’s collaboration. When treating ED, which considerations should clinicians take into account regarding the patient’s partner?

Response by Irwin Goldstein, MD, Posted 10/19/07

Often, the partners of men with ED misconstrue reduced intercourse frequency as emotional withdrawal on the part of the patient.  As a result, studies have shown that the partners of men with ED sometimes develop their own sexual dissatisfaction and sexual dysfunction.¹ Clinicians should remember, though, that couples share more than just their sexual dysfunctions; they also share their sexual solutions.²

Eighty-two percent of female partners of patients with ED perceive sex as important.³ However, female partners reported significantly decreased sexual drive and sexual satisfaction after their partner developed ED.⁴ Furthermore, partners of men with ED report a higher occurrence of sexual dysfunctions, including orgasmic problems, decreased sexual desire, dyspareunia, and vaginismus.⁵

Partners of men with ED play a key role in patient management.  Ninety-one percent of women analyzed in one study initiated their partner’s visit to seek treatment for ED.⁵ One population-based, international survey for men about health issues reported that up to 40% of men felt that their spouse or sex partner played a significant role in motivating them to seek treatment.⁶ Partners also play a key role in treatment adherence and are able to help or hinder the treatment process.^7,8  Partner involvement in the treatment process may improve compliance.^7,9 A study of PDE5 inhibitor therapy with a dropout rate of 31% found that partner disinterest was the second most common reason for discontinuation.¹⁰ Whenever possible, clinicians should involve the partners of patients with ED in the assessment and management strategy^7,9. This allows the clinician to optimize treatment of the patient’s ED and improve the overall health and well-being of the patient, the partner, and their relationship.¹¹

Clinicians have several resources available for assisting the partner of a patient with ED. For partners suffering from sexual dysfunction, clinicians may refer couples to sex therapy.¹² Additionally, when prescribing a PDE5 inhibitor, clinicians should take into consideration the dynamic of the couple.⁹

A shorter-acting agent may result in time constraints, which puts pressure on the patient’s partner during the drug’s period of action.⁹ However, shorter-acting PDE5 inhibitors may be preferred by men who have serious chronic conditions or concerns about having a medication in their bodies for longer than they feel is necessary; couples whose sexual activity is planned and those with a set routine may prefer a shorter-acting agent.⁹ 

A longer-acting agent may make the partner feel more comfortable about timing sexual intercourse, allowing the partner to initiate sexual activity, and allowing the couple to make multiple attempts at sexual intercourse over a longer period.⁹ One study found that the use of a longer-acting agent helped to restore confidence in partners who felt responsible for the erection rather than suspect it is drug induced.⁹

Involving the partner in the treatment plan can improve adherence and can improve the rate of successful treatment outcomes in men with ED.⁹ Patient and partner preferences and satisfaction with therapy are important goals and may influence treatment adherence.⁹ Because reasons behind treatment preference are highly individual, treatment plans may be customized for the patient and his partner.⁹

References

1. Chevret M, Jaudinot E, Sullivan K, Marrel A, Solesse De Gendre A. Impact of erectile dysfunction (ED) on sexual life of female partners: assessment with the Index of Sexual Life (ISL) questionnaire. Journal of Sex & Marital Therapy. 2004;30:157-172.

2. Goldstein I. How the aging male needs to understand female sexual function and vice-versa. Presented at: The 2nd CSSAM/ISSAM North American Congress on the Aging Male. Montreal, Quebec, Canada, February 8-10, 2007.

3. Shabsigh R, Anastasiades A, Cooper KL, Rutman MP. Female sexual dysfunction, voiding symptoms and depression: common findings in partners of men with erectile dysfunction. World J Urol. 2006;24:653-656.

4. Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erecitile dysfunction: the female experience of men’s attitudes to life events and sexuality (FEMALES) study. J Sex Med. 2005;2:675-684.

5. Greenstein A, Abramov L, Matzkin H, Chen J. Sexual dysfunction in women partners of men with erectile dysfunction. IJIR. 2006;18:44-46.

6. Shabsigh R, Perelman MA, Laumann EO, Lockhart DC. Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries. BJU International. 2004;94:1055-1065.

7. Riley A. The role of the partner in erectile dysfunction and its treatment. IJIR. 2002;14(suppl 1):S105-S109.

8. Montsorsi F, Althof SE. Partner responses to sildenafil citrate (Viagra) treatment of erectile dysfunction. Urology. 2004;63:762-767.

9. Dunn ME, Althof SE, Perelman MA. Phosphodiesterase type 5 inhibitors’ extended duration of response as a variable in the treatment of erectile dysfunction. IJIR. 2007;19:119-123.

10. Hatzimouratidis K, Hatzichristou DG. Treatment options for erectile dysfunction in patients failing oral drug therapy. EAU Update Series. 2004;2:75-83.

11. Shabsigh R. Voices of choices: physician, patient, and partner perspectives on the management of erectile dysfunction. J Sex Med. 2006;3(suppl 1):4-9.

12. Lue TF, Giuliano F, Montorsi F, et al. Summary of the recommendations of sexual dysfunctions in men. J Sex Med. 2004;1:6-23.