How To Talk To Your Partner About Erectile Dysfunction

What is Erectile dysfunction? Who does it affect?

The International Society for Sexual Medicine defines Erectile Dysfunction (ED) as “a man’s inability to achieve or maintain an erection suitable for satisfactory sex.”

First, let’s understand how erections occur. With sexual stimulation, the central nervous system commands the muscle tissue to relax and widen arteries so that the penis can fill with blood. When veins constrict to keep the blood inside, the penile erection appears. Once the man ejaculates, the blood is released back into the body. ED can be related to age but also with a man’s lifestyle. Smoking, obesity, drug and alcohol abuse, an unhealthy diet, and poor exercise habits can contribute to other health conditions associated with ED.

ED can also be because of emotional causes. A stressed day at work, something causing fear, worry, anger or frustration, all can be associated with less sexual activity and occurrence of ED. When ED hits, it affects both men and their partners. It affects physically but also mentally.

 

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Conflict with your partner can result in ED.

This could be due to sexual problems in the relationship, general relationship problems, anger, mistrust, or inability to communicate.

How can we overcome embarrassing moments and talk straight about ED? Talking about ED can be a first step in managing this affection and keeping control over it. Speaking of ED with your partner is an act of caring and sharing your feelings. There are many men suffering from this condition and should focus on resolving the problem, not just talking about it or hide it. Open communication is the way to manage this affection and overcome it, together.

 

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What is essential in the discussion with your partner

First, the fact that ED can be managed with the right treatment. It is not the end of the world that this happened. ED can affect any men, at any age, dependant or not of organic causes. Your partner must be aware that ED is not something incurable or permanent.

How talk to your partner about erectile dysfunction?

The direct approach through a private, face to face discussion, is the easiest and the most effective way to approach your partner.  But choose the moment carefully. Do not get emotional after an unsuccessful sex attempt and no not try to be defensive. Wait for another moment to bring this up.

How should women approach the ED problem?

If you have a partner with ED, tell your partner that ED can happen to any man, sooner or later. Don’t blame your partner. Remember, it is not only a man’s problem, it’s a problem concerning the couple as a whole. Be reliable. Ask him about your latest experience in bed, ask him how he feels. If your partner opens up and talks straight about the ED problems, comfort him explaining that it is something he can keep control over. Being supportive will help a lot.

Seeing a specialist together and choosing the appropriate treatment is part of the process.

If you are experiencing ED lately, let your partner know that you are going to take care of this and that you have the intention of seeking professional help.

For any woman, the insurance that the partner will get the right treatment and will be soon back on track is stimulating and comfortable.  Partners need to know that they won’t be able to “cure” ED even if they just try harder in the bedroom, light up the candles or wear sexy lingerie. Stimulation is beneficial in general,  and adding some sparkle to your sex life is fine, but sex toys and a spending the money at Victoria’s Secret will not solve ED. It appears that ED is so common that about half of all men have some degree of erectile dysfunction. And it gets more common as you get older.

 

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What else your partner should know?

Even if ED tends to become more frequent with age, younger men should take it seriously too. ED in younger men can be caused by a stressful period, or an emotional period, like a depression or anxiety. ED may also worsen depression, anxiety and stress.

Performance anxiety?

When feeling so anxious to please your partner, the risk is not to be able to perform sexually at all.

ED is a treatable condition

The best advice at first is making lifestyle changes, like quitting smoking and try to lose a little bit of weight.

Sometimes, oral therapy is prescribed first to reduce anxiety. Men with anxiety or depression may benefit from seeing a counsellor or sex therapist.

Couples may decide to seek counselling together to work on any relationship issues.  A sex therapist can also help a man with performance anxiety, teaching him ways to relax and be more confident about sex. “ED is not a crisis, it’s a speed bump,” says Roger Libby, PhD, a psychologist and sex therapist in Seattle. “You can solve it.”

Options to treat erectile dysfunction 

The development of the phosphodiesterase type 5 inhibitors had a great impact on the treatment of erectile dysfunction.

Phosphodiesterase type 5 (PDE5) inhibitors decrease the activity of the enzyme phosphodiesterase type 5 which normally inhibits penile erection and they are effective only in the presence of the NO stimulation pathway.  Among the PDE5 inhibitors, the most prescribed are; sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra).

These medications help increase blood flow to the penis. These drugs are usually the first method patients try, but they should not be used by men who take nitrates. Patients with slow drug absorption (e.g., Parkinsonian patients) may need to wait 2-3 hours for an erection to develop after taking PDE5 inhibitors.

Other treatments are penile injections, urethral suppositories, vacuum erection devices and penile implants.  Men can learn to inject medication into the penis. This medication helps blood vessels dilate, allowing more blood for an erection. Implants (sometimes called penile prostheses) are surgically placed inside the penis and allow a man to get an erection when he wishes. Nowadays, most penile implants are inflatable devices controlled with a pump. Further sex education can help, too. Knowing what to expect from the experience may build confidence and reduce anxiety.

 

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Cialis & Tadalafil (As Needed)

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Cialis works in a similar way to Viagra and is quicker acting and lasts longer. It can be taken when needed, 30 minutes before intercourse.

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About Cialis

At least one in ten men has trouble getting an erection at some time. Cialis helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis. It reduces the action of the natural chemical in your body that makes erections go away.

How to take it?

You should take Cialis at least 30 minutes before intercourse. Cialis remains effective for 36 hours, meaning it will be easier to keep and maintain an erection when you are sexually excited. It doesn’t matter if you take this medicine with or without food; food has no impact on its effectiveness.

This medicine will only work when you’re sexually excited. You won’t get an erection just by taking Cialis.

What dose should I take?

The recommended starting dose for Cialis is 10mg tablets. If this dose is not effective you can try 20mg tablets. A maximum of one tablet should be taken in 24 hours, however it’s not recommended to take either the 10mg or 20mg tablet every day.

For patients who anticipate sexual activity at least twice weekly, the 5mg “daily” Cialis dose is more appropriate.

Patient Information Leaflet

Always read the patient information leaflet before commencing treatment. The Patient Information leaflets can be found here for 10mg and 20mg dosages.

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Facts about oral medication for ED

1. The first phosphodiesterase type 5 inhibitor that was discovered to have an important effect on penile erection was Sildenafil (Viagra). Nowadays it is released as over the counter medicine in the UK. “Originally, we were testing sildenafil, the active drug in Viagra, as a cardiovascular drug and for its ability to lower blood pressure,” Dr Brian Klee, senior medical director at Pfizer, told French news agency, AFP. “But one thing that was found during those trials is that people didn’t want to give the medication back because of the side effect of having erections that were harder, firmer and lasted longer.’’

Since then, Viagra, known as “the blue pill”, is the most renowned male sexual performance drug in the world. Viagra is administered orally, once a day. The recommended dose in adults is 50 mg taken as needed approximately one hour before sexual activity. To be effective, sexual stimulation is required.

Patients must consult a physician and follow carefully all instructions if they intend to use Viagra. In a comparative study, evaluating the onset of penile rigidity in men with ED treated with Sildenafil Citrate and Tadalafil (Cialis), Viagra’s median time of action for the patients who obtained erections for sexual intercourse was 25 minutes with a range of 12-37 minutes.

In a separate study, Viagra was still able to produce an erection in response to sexual stimulation 4-5 hours post administration. Viagra proved effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy.

2. Tadalafil (Cialis) is a selective, reversible inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).

Cialis received the approval to be used in Europe in 2002 and in the United States of America in 2003.  Cialis was the third phosphodiesterase type 5 inhibitor to come onto the market after Viagra and Levitra.

The guidelines of the International Society for Sexual Medicine (ISSM) Standards Committee for Sexual Medicine suggest that treatment with PDE-5-inhibitors can be effective in most erectile dysfunction aetiologies except after severe damage of the parasympathetic cavernous nerves. The relatively long half-life of tadalafil (17.5 hours) allowed the confirmation of highest potency for PDE-5 inhibition, successful clinical development and subsequent regulatory approval of tadalafil.

Tadalafil is also recommended for Benign Prostatic Hyperplasia and can be administered to patients with either Erectile Dysfunction, either Benign Prostatic Hyperplasia or both.6 Depending on the patient and the indication, tadalafil can either be taken daily with the lowest dose of 2,5 mg or it can be taken as needed.

Either original or generic, medicinal products with tadalafil require a prescription from your doctor and are also required to undergo continuous post-market surveillance to prove a safety profile. Just like Viagra, tadalafil is contraindicated in patients administering medications that contain nitrates, which are usually prescribed for the treatment of angina pectoris. One of the most frequently prescribed nitrates is nitroglycerin, which can also be found in creams, sprays, candy, and blisters. Other drugs containing nitrates include isosorbide dinitrate or isosorbide mononitrate.

The combination of nitrates with tadalafil can cause a rapid decrease in blood pressure that can lead to heart attack, stroke, and sometimes to death. Tadalafil is also contraindicated to use with alpha-blockers of any type. Alpha blockers prescribed to people who suffer from high blood pressure and prostate adenoma.

You should consult your doctor or pharmacist to find out whether your medication contains nitrates or alpha-blockers and to find out if you are eligible to receive a prescription containing Tadalafil.

3. Levitra contains vardenafil hydrochloride and is taken on as needed basis.

For most patients, the starting dose is 10 mg, up to once daily. A dose increase to 20 mg or decrease to 5 mg is based on individual efficacy/tolerability. A starting dose of 5 mg Levitra should be considered in patients ≥ 65 years of age.
Levitra is taken orally, approximately 60 minutes before sexual activity.

The maximum recommended dosing frequency is one tablet per day.  Levitra may be taken with or without food.

Just like the previous mentioned PDE5 inhibitors, Levitra can cause your blood pressure to drop suddenly if taken with certain other medicines.

3. Stendra contains avanafil and it can be taken with or without food. It can take effect in 15 minutes.

Its effect lasts for up to 6 hours. It can be consumed with a moderate amount of alcohol, its action is not being influenced by small amounts of alcohol. Available doses of Stendra are 50 mg, 100 mg, and 200 mg.

The recommended starting dose is 100 mg. However, it is recommended to take the lowest dose that works for you. Stendra is administered once a day. Among the side effects of Stendra are listed: a headache, flushing, stuffy or a runny nose, sore throat and back pain.

All patients suffering from the below-mentioned conditions must get approval from a physician before starting the administration of PDE5 inhibitors.

• heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack—ask your doctor if it is safe for you to have sexual activity;
• low blood pressure or high blood pressure that is not controlled;
• pulmonary hypertension;
• stroke;
• seizure;
• prolongation of the QT interval (long QT syndrome);
• liver problems; • kidney problems (dialysis required);
• retinitis pigmentosa, a rare genetic (runs in families) eye disease;
• severe vision loss or an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION);
• stomach ulcers;
• bleeding problems;
• deformed penis shape called Peyronie’s disease;
• an erection that lasted more than 4 hours;
• blood cell problems such as sickle cell anaemia, multiple myeloma, or leukaemia;
• hearing problems.

It is very important to monitor closely your blood pressure during the treatment with selected PDE5 inhibitors. Side effects are examined in more detail here.

 

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Ten pieces of advice to conclude:

1. Communicate with each other.

2. Choose a good moment to talk about the topic and to eliminate the sexual frustration and be comfortable when you talk to your partner.

3. Choose a good moment, invite her over a glass of wine or on a walk. Talk about how you feel and be ready to listen. Focus on how you want to approach the problem together.

4. Go see a doctor or a sex therapist together. You will be surprised to find out that maybe some medication you are taking is related to the onset of ED. Also available for drinking alcohol, overweight and a sedentary life. Some link ED also to heavy smoking.

5. Start the ED therapy with the appropriate medicine and monitor the evolution.

6. Stay positive.

Holly Richmond, PhD, a somatic psychologist and certified sex therapist in Portland, OR, and Los Angeles advises patients with ED to try to relax because ED can put a big pressure and feel like such a big deal sometimes, “like it’s the beginning of the end of your sex life”. One must try to stay positive because the erections will happen again. “I reassure clients that there’s usually another erection just around the corner”, Dr Richmond says.

7. Remember to have your part of the fun during sex.

8. Instead of trying to be perfect, enjoy yourself, try to rediscover what you enjoyed most in the past.

9. Remember that you’re a couple, you could come out of this with a more satisfying, flexible, and enjoyable sex life than you had before.

10. Making tiny but continuous steps, you will overcome ED but take into account that ED can reoccur whenever stopping your ED medication. When facing erectile dysfunction, addressing the issue to the doctor and getting the right treatment are of utmost importance. We are here to help.

 

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References:
1. http://www.issm.info/sexual-health-qa/what-is-erectile-dysfunction1/;
2. M Boolell M, MJ Allen, SA Ballard, S Gepi-Attee, GJ Muirhead, AM Naylor, IH Osterloh, C Gingell – Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction;
3. Chiang et al. The dangers of sexual enhancement supplements and counterfeit drugs to “treat” erectile dysfunction;
4. http://www.ema.europa.eu/Cialis- Summary of product characteristics;
5. Porst H, Burnett A, Brock G, et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med 2013;10: 130–71;
6. Tadalafil 10 mg film-coated tablets- Summary of Product Characteristics;
7. https://gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Brands/LEVITRA/pdf/LEVITRA_PI.PDF#page=24;
8. https://www.stendra.com/;
9. R. Morgan Griffin- Getting Intimate: Talking Together About ED.

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