We've all seen the commercials. An elegant couple strolls along the beach at dusk. He looks rugged and heroic... she looks content. Why? It's all because he takes a drug that lets him overcome erectile dysfunction (ED), the persistent inability to gain and maintain an erection sufficient for sexual intercourse.

If you are a woman whose partner suffers from ED, you may know all too well that the problem can extend beyond what any drug can remedy. ED doesn't affect only sex-it challenges a man's self-image (and sometimes a woman's), tests a woman's patience and can hurt a relationship much more broadly. Women's most common questions…

Does ED mean the end of our sex life?

It doesn't have to. Actually, your first question should be, "Does my man really have ED?" It is normal for a man to occasionally be unable to start or complete intercourse, usually because of fatigue or excess alcohol consumption.

True ED means that a man can seldom or never get and sustain an erection or avoids sex because he's worried that he might not be able to. This condition affects more than 25 million American men, according to the American Urological Association.

Vicious cycle: Sometimes a man will have trouble once or twice-and then become terribly embarrassed or filled with dread that he has ED. His partner may become equally anx- ious, and they may feed each other's worries, compounding the stress. Such worry itself may cause "performance anxiety" that leads to ED.

What to do: If your partner has erection trouble, remain calm, supportive and, most of all, optimistic. Calmly focusing on relaxation and pleasure, as described below, can often bring erections back.

Is this happening because I'm not attractive to him anymore?

Even though a woman may know that ED can have medical and psychological causes that don't stem from the relationship, she still may find herself reacting emotionally to her part- ner's problem in one of two counterproductive ways…

  • She doubts herself. She feels she isn't attractive or sexually skilled enough to excite him.
  • She gets angry. She thinks, I'm attractive. This is his fault. If her partner starts to associate trying to have sex with being blamed for fail- ing, he will avoid it-making her angrier. Anger destroys intimacy.

The truth: Your man's ED has little or nothing to do with your desirability. If he has had an erection with you before, you probably are attractive to him. If he simply weren't interested, he wouldn't go through the drama of trying and failing.

Next step: Don't lose your intimate connection. Not every sexual experience must end in intercourse. In fact, variations from the same kind of sex you've always had will probably increase your mutual desire, which may help reduce the psychological effects of ED.

Make it okay to snuggle, caress and kiss without expecting intercourse. Casually explore each other's bodies...ask him where and how he would like to be touched.. tell him the same about you. If you both want it, he can bring you to orgasm manually or orally, but don't make this a pressured demand. Talk...laugh with each other...realize that you are simply facing one of life's many challenges together. At first, he may not believe that you are not angry or horribly disappointed. Be gently persistent in saying that this kind of contact is pleasurable to you.

When I try to talk about it, he shuts down. Why won’t he get help?

You may think he is ignoring the problem or doesn't care.

The truth: He isn't ignoring his ED—it is plaguing him. But if you push him too hard, he may retreat even more. At this point, you have to walk a tightrope of gently addressing the issue without showing anger or Name. If he reacts negatively, don't take the bait. Instead, say, 1 am sorry that it's painful for you, and I want to help you through this." Do your best to he accepting and nonjudgmental. When a man pushes back ("Leave me alone"). he may in fact be testing you, wanting assurance that you still are on his side.

What can be done medically for ED?

He should go to his doctor, who may refer him to a urologist for a complete checkup to look into the following potential causes of ED…

  • A chronic condition that affects the nervous system or circulation, such as diabetes.
  • A side effect of medication, such as a blood pressure or chemotherapy drug, an antidepressant or an antihistamine.
  • A side effect of surgery, such as for prostate cancer.
  • Injury to vascular, neurological, hormonal or muscular systems—from an accident, for example.
  • Lifestyle issues, such as alcohol misuse, long-term smoking or excessive fatigue.

There is a two-part method of dealing with ED caused by physical problems. It's called "fix and foster." First, with the physician, fix the underlying problem, if possible. (When ED is caused by damage to the neurological or circulatory systems, the ability to gain an erection sometimes can’t be recovered.)

The couple also may need to work on the -foster" part—teaming up on healing the anxiety and other negative emotions caused by ED.

Beware: If a doctor prescribes an ED drug without first trying to diagnose the root cause, find another doctor. Treatment should progress in increments to find the least intrusive solution.

Direct treatment of ED can include an oral drug such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra)...or the drug alprostadil (Caverject) applied directly to the penis either by injection or penile suppository. All these drugs promote blood flow to the penis.

Some couples prefer non-drug equipment, such as a splint that supports the penis or a vacuum device that draws blood into the penis. A magical penile implant is a treatment of last resort.

What if there’s no physical cause?

Seek the help of a professional sex therapist, who can help both of you as a couple. This counselor can show you how to overcome ED and incorporate drugs or other treatment into your life—not just your sex life. He/she should work in cooperation with your partner's physicians.

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