How you and your partner can cope with a man's most sensitive sexual situation
You love him, he loves you, and you wouldn't want anyone else by your side as you tackle life's good and bad moments. But even the closest of couples can get tripped up trying to deal with—or even talk about—erectile dysfunction, politely referred to as E.D.
For men in their 20s, E.D. is a rare event, but in later decades, its likelihood increases exponentially. The best solution is not necessarily a little blue pill; now there's a menu of options that can both help him perform better and draw the two of you closer. In fact, it's not Pollyannaish to see impotence as an opportunity. "E.D. can break you out of a sexual rut," says Marianne Brandon, PhD, a clinical psychologist and sex therapist in Annapolis, MD. "It can be a time to tap into creativity and share intimacy in ways you hadn't explored."
But for a woman, having a partner with E.D. can be tinged with emotional issues.
"If a man becomes impotent, a woman's first thought is often He's not that into me anymore," says Louann Brizendine, MD, a clinical professor of psychiatry and director of the Women's Mood & Hormone Clinic at the University of California, San Francisco. "She might think, It's not that big a deal, just to soothe his ego." And the man, worried about disappointing his partner, may shy away, further decreasing her libido. "When a man becomes apprehensive about his erection, it can turn into a self-fulfilling prophesy," says Dr. Brandon. So the sooner the two of you come up with a plan of action, the better.
If you're not sure whether his E.D. is due to physical or emotional causes, try this nocturnal penile tumescence (NPT) test: Have your partner tape a strip of postage stamps around the shaft of his penis before bed, says Eric R. Braverman, MD, founder of PATH Medical Center and a clinical assistant professor of integrative medicine at Weill Cornell Medical College in New York City. Healthy men of any age have three to five spontaneous erections during sleep. If the strip tears at night, it means he had an erection and is physically capable of getting one during sex.
There's also an NPT monitor test, which is prescribed by a doctor but performed at home over a 3-day period. It involves a small, portable computer connected to two bands placed around the shaft of the penis. The computer records the presence of an erection occurring during sleep.
Common medical culprits behind E.D. are high cholesterol and high blood pressure (both slow blood flow to all parts of the body, including the penis). Side effects from medications such as blood pressure drugs and antidepressants are also notorious, so talk to your doctor about the meds your man is on. Doses can be adjusted, or different drugs—without the E.D. side effect—can be prescribed. (For example, Cozaar, unlike many anti-hypertensives, actually improves sexual dysfunction.) If lagging testosterone levels are to blame, he can use a prescription hormone replacement. In a worst-case scenario, a poor erection can signal heart concerns 2 to 5 years before they're discovered in heart-specific tests, which is why your doctor's timely involvement is crucial.
Some cases of E.D. subside when a man begins to eat better, lose weight, or stop smoking. Nudge him out the door for walks (no marathons necessary), and plan heart-healthy meals. "Research shows that the Mediterranean diet is the healthiest for men with erection problems," says Dr. Brandon. The focus on natural foods with healthy fats, such as nuts and olive oil, helps clear blood vessels of dangerous plaque and boosts production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. A Mayo Clinic study found that men who changed their daily routines to improve their cardio health—such as dropping pounds and exercising—also lowered their incidence of E.D. Other data found that men who kicked the tobacco habit enjoyed more rigid erections than those who kept lighting up.
If your partner is feeling dejected, tense, or anxious, E.D. can be an unwelcome side effect. And for many men, it doesn't take a life trauma to bring on E.D., says Dr. Brandon; daily stress and tension, unfortunately, can be enough to introduce sexual dysfunction. If this is the case with your husband, you may want to suggest that he see a sex therapist, a professional who is specially trained in helping patients unravel the emotional causes of E.D. and can provide tools to address it.
A shift in bedroom behavior can also work wonders for you both. "Transfer the focus from intercourse to pleasure, so sex becomes less about his erection," suggests Dr. Brandon. "At the same time, don't think of his penis as off-limits. Even if he doesn't get erect, it doesn't mean he doesn't get pleasure out of it. Many people don't know it's possible for men to have an orgasm without an erection. Erections involve the swelling of blood vessels; orgasm and ejaculation involve muscle spasms. These are two different processes, and they don't have to occur together." Sharing erotica, trying out body massage, and introducing vibrators into sexual activity can all offer new channels of satisfaction and connection.
Certain sexual positions also increase the stimulation that keeps him erect, says Lou Paget, a Los Angeles–based certified sex educator and the author of How to Be a Great Lover. She suggests that if your partner prefers to be on top, you may want to try closing your legs to create a tighter entry. Or try side by side, facing each other with your upper leg over his hip to prevent him from slipping out.
If all else fails, there's always Viagra and its brethren, Cialis and Levitra, which promote increased blood flow to the genital tissues. Known as PDE5 inhibitors, this class of drugs is highly effective but can take the spontaneity out of sex, because couples need to wait 30 minutes to an hour for the man to get erect and ready for intercourse. However, these drugs are extremely popular, with more than 18.5 million prescriptions written in 2010 alone.
If his E.D. doesn't respond to these therapies, there are other more aggressive, doctor-prescribed remedies. These include self-injections of medicine into the penis (using very fine, short needles for minimal pain); a vacuum device that draws blood into the penis, causing an erection (an elastic ring is then placed at the base of the penis to keep it rigid); or suppositories inserted into the urethra to create an erection.
Another resort is implant surgery—the insertion of inflatable cylinders that fill with fluid when a pump inside the body is pressed to make the implant hard. Researchers are also investigating bypass surgery and even stents to repair blockages in arteries that feed the penis. "Viagra has increased the use of all treatments for sexual dysfunction," says Irwin Goldstein, MD, director of San Diego Sexual Medicine at Alvarado Hospital. In 2010, more than 100,000 men have opted for these alternatives.
Your supermarket and health-food store also hold some treatments to help with E.D.
Food In a study in the International Journal of Impotence Research, men who drank pomegranate juice for 4 weeks had improved scores on an E.D. assessment. Turkish researchers recently showed that eating 100 g (3 1/2 ounces) of pistachio nuts a day for 3 weeks improved men's E.D., with no side effects.
Prelox This OTC supplement combines L-arginine with Pycnogenol (a pine bark extract), which has been shown in several studies to improve sexual function.
L-arginine Found naturally in food, this amino acid increases production of nitric oxide. It's been shown to improve E.D., but only in men with low levels of nitric oxide, such as that linked to cardiovascular problems.
Red Ginseng A multistudy from the University of Exeter recently found that using this herb significantly improved erectile dysfunction in its male subjects by relaxing muscles in the penis for better blood flow, helping to cause an erection.