Q: What causes a man to not be able to “finish” in the bedroom? Is this because of an emotional disconnect from the wife? Does he want to be with someone else?
A: Thanks for your question. Erectile dysfunction (ED), defined as the inability of a man to attain and/or maintain an erection that is sufficient for sexual performance,1 is the most common sexual disorder among men in many parts of the world (hence all the commercials for the little blue pill).2 For example, in a population-based survey of men in Vienna, over 1/3 of respondents (out of a large sample of over 2,000) experienced some form of ED in the past year (see my column for how ED affects a man’s sexual partner).
There are many explanations for why men experience ED. For example, physiological factors like cardiovascular disease, endocrine pathway problems, and penis tissue failure all affect a man’s ability to achieve and maintain an erection.3 Importantly, psychological factors pose an even greater risk factor for ED. In the Vienna study described above, psychological stress was the most frequently cited and best predictor of ED; it was a greater risk factor than both physical activity and alcohol consumption.4 Because of feelings of embarrassment about ED, many men tend to downplay the role that psychological factors may play with regards to their ED, focusing more on the physical possibilities5— it is easier to blame the body than the psyche. For example, in a survey of couples affected by ED, men were more likely to underreport relationship problems (e.g., arguments & conflict) as contributing to the ED than were their sexual partners.6
ED often has a negative impact on self-esteem, sexual confidence, and relationship satisfaction for men.7 Over time, many couples decrease or cease sexual activity altogether, and this can add even more distance in the relationship than may have been there to create the ED in the first place.8 In other words, ED is sometimes more of a symptom of problems in the relationship than it has to do with the man’s physical ability to maintain an erection. It is also certainly possible that your husband’s lack of sustained sexual interest is a sign of desired or actual infidelity; if that is the case, then you and your husband will need to address the reasons for his wanting to stray–marital or intimacy problems may underlie the reasons for his decreased sexual desire in you. Again, the infidelity, or desired infidelity may be a symptom of relationship problems, not a cause of the ED. Clinicians argue that for such couples, treating ED itself (e.g., with drugs) will not help, as the couples will likely sabotage treatment because the real problem is intimacy– without intimacy, the sexual outcomes will not be great for either partner, even if they guy is able to get an erection with the help of the famous blue pill (or similar alternative).
Therefore, the cause of your husband’s ED might include physical/health issues, but the data generally indicate there may be psychological or relationship issues that are contributing to the problem. So what can you do? Clinicians recommend finding ways to restore intimacy in your relationship, such as increasing positive communication, spending more and better quality time together, and introducing more foreplay to your sexual activities – all of these suggestions will improve your sexual relationship with each other.8 And if that doesn’t work, couples counseling can be very effective as well.
1Jardin, A, Wagner, G., Giuliano, F., Padma-Nathan, H., & Rosen, R. (2000). Erectile Dysfunction. Health Publications..
2Kubin, M., Wagner, G., & Fugl-Meyer, A. R. (2003). Epidemiology of erectile dysfunction. International Journal of Impotence Research, 15(1), 63–71.
3Heaton, J. P. W. & Adams, M. A. (2004). Causes of erectile dysfunction. Endrocrine, 23, 119-123.
4Ponholzer, A., Temmi, C., Mock, K., Marszalek, M., Obermeyr, R., & Madersbacher, S. (2005). Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire, European Urology, 47, 80-86.
5Tiefer, L., & Schuetz-Mueller, D. (1995). Psychological issues in diagnosis and treatment of erectile disorders. Urolologic Clinics of North America, 22, 767-773.
6Tiefer, L., & Melman, A. (1983). Interview of wives: a necessary adjunct in the evaluation of impotence. Sexual Disabilities, 6, 167-175.
7Altof, S. E., O’Leery, M. P. O., Cappelleri, J. C., Glina, S., King, R., Tseng, L., & Bowler, J. L. (2006). Journal of General Internal Medicine, 21, 1069-1074.
8Dunn, M. E. (2004). Restoration of couple’s intimacy and relationship vital to reestablishing erectile function, Journal of the American Osteopathic Association, 104, S6-S10.
Dr. Jennifer Harman – Adventures in Dating… | Science of Relationships articles | Website/CV
Dr. Harman’s research examines relationship behaviors that put people at-risk for physical and psychological health problems, such as how feelings and beliefs about risk (e.g., sexual risk taking) can be biased when in a relationship. She also studies the role of power on relationship commitment.