Erectile Dysfunction - Insights for Women

Three questions women should ask about ED treatment

Erectile dysfunction (ED) is estimated to affect up to 30 million men in the United States. The most common oral medications approved for the treatment of erectile dysfunction are: Sildenafil (Viagra), Vardenafil (Levitra) and Tadalafil (Cialis). They work by blocking the phosphodiesterase-5 (PDE-5) enzyme, which allows the smooth muscles of the penis to relax to promote increased blood flow which can help a man to achieve and sustain an erection.

In men, these medications can be effective treatments for ED; however, they are not suitable for everyone and there are side effects. These and other issues can impact a man’s partner as well. Download an informational fact sheet to share with your doctor about the importance of including wives and partners in discussions about ED treatment.

Before his urologist writes a prescription, there are a few questions you should ask.

Will I be included in the medical consultation(s)?
Many men view erectile dysfunction as a male problem and it may not occur to them to include their wife or partner in a discussion with the doctor. Women tend to view ED as a couple’s problem since it impacts both people in a relationship.

Will couples counseling with a sexual health therapist be a part of treatment?
Studies have shown medication in conjunction with counseling is more effective than just medication alone. Requesting a referral to a sexual health therapist is a good idea. Resuming lovemaking after a long hiatus can bring up a host of emotional and psychological issues which couples need to discuss and may need help in resolving.

According to one study, almost 35 percent of patients discontinued the use of Viagra – even after successful restoration of sexual function. Why? The reasons reported were primarily emotional or relationship oriented. Some of the factors contributing to patients’ discontinuing treatment included:

• Length of time the couple was asexual before seeking treatment
• Male partner’s approach to resuming sexual activity with his partner
• Male partner’s expectations of how PDE-5s will change his life
• Each partner’s physical and emotional readiness to resume lovemaking
• The meaning for each partner of using a medical intervention to restore lovemaking ability
• The quality of the couple’s non-sexual relationship

What are some of the issues couples may experience in regard to ED treatment?
In one New Zealand study, women listed the following concerns about their partner’s use of PDE-5s:

• Decrease in foreplay and an excessive focus on penetrative sex
• Less emotional connection with their partner
• Unwanted change in habits, duration, frequency and mode of sexual activity
• Offended by their partner’s reliance on a  “chemically induced” erection
• Fear of addiction
• Pain caused by increased sexual activity
• Lack of consultation/negotiation as to the initiation and frequency of sexual activity
• “Sex on demand” (i.e.,  overt and subtle pressure from partner to have sex)
• Side effects from medication
• Worries about infidelity
• Coercion to have sex in order to “not waste a pill” and to “get their money’s worth”

Is the drug safe for my husband/partner to use?
PDE-5 inhibitors are an appropriate choice for men who are in relatively good health.  However, these drugs are not for suitable for everyone. Men who take nitroglycerin for angina or certain types of alpha-blockers for high blood pressure and benign prostatic hyperplasia should not take PDE-5 inhibitors. Men with the following conditions should not take PDE-5 inhibitors without the recommendation of their doctor and even then should use them with caution:

• Severe heart disease (unstable angina, recent heart attack or heart arrhythmias)
• Recent history of stroke
• Hypotension (low blood pressure)
• Uncontrolled hypertension (high blood pressure)
• Uncontrolled diabetes
• Severe heart failure
• Retinitis pigmentosa (People with this disease do not respond to PDE-5 inhibitors)

What are the possible side effects of using PDE-5 drugs?
Common side effects reported by men taking PDE-5 drugs include: flushing, upset stomach, headache, nasal congestion, back pain and dizziness. There have been reports of fatal heart attacks in a small percentage of men taking Sildenafil. Less common side effects include: vision problems, hearing loss, seizures and an increased risk of priapism (sustained, unwanted and painful erection). Report these and any other side effects you experience to your doctor.

Getting Help
Schedule an appointment with a urologist to discuss medical treatment options for erectile dysfunction by calling 234.867.7965.