Challenges in Care for Erectile Dysfunction: Holistic Psychosexual Treatment Approach and Efficient Sexological Counseling — Part 3

How does the partner affect treatment outcomes? 

Healing with the partner is fundamental, as the association between sexual dysfunction in men partnered with women with FSD increases the likelihood of ED by 400 % and 100 % the risk of fast ejaculation.(1) 

The partner needs to be included in the assessment and treatment, and treatment options for ED are essential. Successful therapy requires a supportive and available sexual partner.(2)

Essential components are mutual sexual attraction, shared sexual status, and motivation, e.g., whether partners are interested in engaging in joint sexual activities.(2)

The more problematic the relationship, the less likely the patient-partner sex education and sexual communication skills training will be able to support positive outcomes.(2)

Sexuality therapy for the partner alone may be needed if the partner’s support is absent.(3) 

High relationship dissatisfaction predicts ED and PE in couples.(4) 

Therefore, the couple must take responsibility for their relationship and sexual satisfaction by seeking help and timely treatment and “stop taking each other for granted.”

A man with ED who avoids sexual intimacy with his partner is more likely to benefit from psychosexual, couples therapy, and pharmacotherapy.

Cases A, B, and C

A: Presentation: South-East Asian-American 47-year-old male experiencing difficulties with arousal and erection loss. He was diagnosed with ED and received PDE5 inhibitors. Still, he was reluctant to use medicine as it was not giving the desired effect due to a lack of sexual arousal because of lack of stimulation and performance anxiety. Perceived low libido but appeared mainly unmotivated.

Background: Divorced, now engaged to re-marry to start a family, but he was hesitant due to not feeling sexually wanted and loved and questioning his relationship. 

He then met his ex-wife while visiting to pick up their child, and then an unplanned, spontaneous sexual interaction happened, as his ex-wife shared with him that she still loved and desired him. He experienced intense, lasting sexual arousal, pleasure, and satisfaction as if the whole ED was gone. 

Results: He described eroticism, a feeling of being wanted, enough sexual stimulus, no performance pressure, familiarity – a novelty in balance, and embodiment “out of his head” instead of catastrophizing. 

Solutions: He started relationship counseling with the new partner to manage the obstacles to deeper emotional intimacy. The couple also started sexual therapy to overcome ED due to performance anxiety and lack of stimulation and psychoeducation to improve sexual communication for enhanced compatibility.

A deeper issue for the client to contemplate: the foundation of the new relationship? Overall compatibility? Together for the right reasons? 

B: Presentation: British Male, 42 years old, complaining of erection loss due to fast ejaculation; a married couple of 12 years, but stating that “wife has never complained.” At the same time, his focus on partner satisfaction reduces his opportunity to receive pleasure. 

Results: Overall satisfying sexual life based on mutual sexual attraction, desire, and sexual variety. Additionally, both partners have agency and freely communicate their needs.

Solutions: Sexuality counseling for the couple to focus on supporting the male in expressing his needs and wants to enhance his sexual pleasure and satisfaction and to reduce partner-focused sexual performance.

Sexological counseling for the male and the couple to discover the Stop-Start -method to learn to delay ejaculation, manage performance anxiety, and other individual factors causing his rapid climax. 

The client reached the full ability to control his ejaculation in 2-4 weeks by method training with his partner and felt they solved the problem.

C: Presentation: Lebanese-Australian Male, 33 years old, engaged, perceiving low libido but avoiding partnered sex. He has performance anxiety based on the cycle of erection loss and feelings of shame because of it. He is also feeling guilty about other sexual partners on the side and performing well with them.

A urologist found no organic causes. Secretly from partners, he was using PDE5i from time to time for performance anxiety.

Results: The primary partner’s complaints of lack of sexual intimacy escalated to a deepening couple conflict and calling off the engagement.

Solutions: The couple started couple and sexuality counseling to overcome performance anxiety and shame for “good enough sex.”

The male was referred to psychotherapy and EMDR therapy due to his history of sexual abuse during adolescence and possible avoidant-insecure attachment style due to early childhood family dynamics. His emotional ambivalence can cause arousal and erection problems, along with the fear of intimacy and commitment to one partner.

Christina Lindea Saarinen
Psychosexual and relationship therapist

References

1. Chew PY et al. J Sex Med. 2021 Jan;18(1):99-112
2. Perelman MA, et al. Int J Impot Res. 2003;15 Suppl 5: S67-74;
3. Perelman MA, 2005. Combination therapy for sexual dysfunction: Integrating Sex Therapy and Pharmacotherapy.
4. Rust J, et al. 2018. Marital Problems and Sexual Dysfunction: How they are related? The British Journal of Psychiatry.