Erectile dysfunction: a couple problem.

©FFPRHC J Fam Plann Reprod Health Care 2007: 33(1) Background It used to be called ‘impotence’: a double-edged label, with its implication not only that the man is unable to persuade blood into his penis, but also that he’s powerless in sexual situations, in the relationship arena, and in life. The word was never just a medical description; it always held undertones of accusation – a word to be hurled across the room during late-night arguments. How preferable that we now use the term ‘erectile dysfunction’ (ED): descriptive, non-judgmental, and with no misunderstandings. Problem is, there’s still a misunderstanding here, and a serious one at that. We still think that ED is only about the man, his penis and his problem. Wrong. Yes of course the man suffers – and deeply. It’s not just the day-to-day lack of sexual performance, not just the panic that normal service will never be resumed. It’s also the low self-esteem, the failing confidence when he compares himself with other men. It’s the guilt at what he sees as failure towards his partner. And it’s the intimation if not of mortality, certainly of frailty and old age. ED can all too easily turn into a symbol of male helplessness and hopelessness, which is why the original ‘im-potent’ term struck disturbingly to the very heart of the problem. So yes, the man suffers. But what not only my postbag but recent studies1 suggest is that the man’s partner suffers too. And that means that his ED can also become her (or conceivably, his) sexual and emotional dysfunction, and then become a relationship dysfunction rippling out through the whole of the couple’s lives.