Does my husband have erectile dysfunction (ED)?

There are a couple of different disorders that the average person may be thinking of when they say the phrase "erectile dysfunction." For the sake of being a bit more clinically precise, I'll give you the shorthand version of what you may be referring to (and for the more articulated version, we consult with the DSM-V, our therapeutic manual for diagnostic criteria).

Short Version: What is "ED"?

Delayed Ejaculation: the marked delay, infrequency or absence of ejaculation in 75% or more of partnered sexual activity, for a minimum of 6 months

Erectile Disorder: one of the following must be present in at least 75% of sexual activity: difficulty obtaining erection, maintaining erection to completion, or decrease in the firmness of the erection. Again, for a minimum of 6 months

Premature Ejaculation: a persistent or recurrent pattern of ejaculation within 1 minute of vaginal penetration, persistent for 75% or more of sexual occasions for at least 6 months

Now...we have some caveats (and this is why you should seek help from a professional and licensed sex therapist in order to sift through the mud). In the clinical setting, we work together to identify the source of the issue. For example:

• a new medication that affects his circulation

• a recent death in the family

• an unspoken communication issue in the relationship

• his weight or overall health

• his masturbation habits (yes, what he does in his alone time)

• a history of sexual or familial trauma

• a sexual dysfunction in the female partner (like vaginismus) that creates a co-occurring sexual dysfunction for the man (he may subconsciously want to finish faster - or not get hard at all - out of fear of hurting her)

• the style of partnered sex (too rough? minimal stimulation? unrealistic expectations for lasting "all night long?")

• getting mad at him/rejecting him during the occasions that his penis doesn't perform the way you'd like (or him mentally putting himself down)

• and...this list goes on and on

There is also the question of frequency. What if you two have avoided having sex because of the one time that it didn't...quite...work? How can we slap a label of "erectile dysfunction" on him if you have only had partnered sex twice within the last 6 months?

Okay, but What if He Won't Admit that Erectile Dysfunction is Affecting Him?

Sex is already such a vulnerable topic - and an issue with sex compounds the potential shame that someone may feel. We put pressure on ourselves to be able to function at 100% capacity, 100% of the time. And for men, there can also be added societal messages around making a woman orgasm, performing like a stallion, having the "right size penis," etc. There are a lot of reasons to feel uncomfortable when talking about sexual performance.

I advocate strongly for tenderness and unconditional positive regard in my work as a sex therapist. The couples that I work with learn how to approach the vulnerability of sexuality together as a unit. But we have to acknowledge the damage that may be done long before two people reach the therapeutic couch. An ex partner may have ridiculed or demanded perfection. A family member may have inflicted trauma. A social group may have reinforced toxic stereotypes.

To put it plainly, we are swimming upstream here. No wonder he may not want to broach the topic of..."is it me?"

And while women are socialized to ask for help sooner (and have, as a whole, received less negative feedback when they do request help), it is worth acknowledging that men generally have the opposite experience.

How to be Supportive if Your Significant Other Has ED

I'll start with the most simple option refrain from verbal or non-verbal messages that communicate condescension, punishment, or that you don't believe in him

That means:

• refrain from exasperated sighs or turning your back on him

• no asking "why can't you just get it up?"

• "what's wrong with you?" is probably not a great intro either

• and babying him...also not the move. Be his woman, not his mom!

We want to see sexual concerns as a phenomenon that "we" handle together. This is why I love being a sex therapist; I get to help couples learn how to turn towards each other when sex gets hard - rather than isolating and trying to find a solution on their own. It just becomes so much lighter when everyone is one the same page and can bring patience and understanding to the table.

Some versions of communication that cue up a "we" mindset may be:

• "What would make sex feel more fun for us?"

• "Is there anything about life that is creating added stress? What can we do to lighten up the load?"

• "I'm just enjoying being close with you right now; I feel very full" (for in the middle of a sexual experience where intercourse isn't accessible)

"And what if he rejects my support?"

Now we have definitely found our way into couples therapy/sex therapy territory. Intimacy and open communication works when both partners are willing participants. Stonewalling, defensiveness, contempt and criticism (the "four horsemen," according to Dr. John Gottman) are all going to sabotage the group project and any chance of successful solution-finding.

At this point, I definitely recommend seeking professional intervention with a sex therapist to help break the ice and understand why there is so much resistance to talking about such an important part of the relationship. If you reside in Buckhead, Midtown, or surrounding neighborhoods in Atlanta, Georgia, I'd love to be that person for you both. If you live outside of Atlanta, you can find sex therapists through general directories like Psychologytoday.com, or by looking through sexuality-specific clinical organizations like the American Board of Christian Sex Therapists (ABCST) or the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

Next Steps if You Think ED is a Factor

I love a good set of simple actionables.

1. Create a supportive, loving environment

2. Start the conversation with a "we" approach

3. Consult with a sex therapist for evidence-based interventions that are proven to improve ED

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about the author

Hi, there! I'm Sade (shah-day). I am a licensed marriage and family therapist in the metro Atlanta area specializing in couples and sex therapy. I also am the voice behind the My Intimacy Therapist Podcast, and host date nights for singles and couples in the metro Atlanta area.

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