Opinion piece: Myths surrounding the investigation and treatment of erectile dysfunction (Part 5)

Is there a subset of ED patients who can be managed in isolation? Conversely, should we insist on couple management with certain individuals?
Riley et al reviewed case records from 128 consecutive men presenting with ED whose partners attended on the first or second visit. The duration of ED varied from several months to 40 years. Interestingly, over one-half of the couples had not experienced any mutual sexual activity for about 2.5 years. Over 80% of the men and only 20% of the female partners considered intercourse important. ED frequently results in complete avoidance of sexual activity; because men are often the initiators of sexual activity, it was suggested that there is no sexual activity among couples where the man has ED. How often have we heard the following phrase when treating men: “Why should I start something I can’t finish?” Longstanding ED often results in significant relationship damage that will not be repaired by a hard penis. These patients require either short or long term supportive counselling and we should require the partner’s attendance at some point during the consultative process. In the Canadian model, family physicians should be encouraged to refer both members of the ED couple (to a urologist/sex therapist?) for assessment in these situations. ventolin inhaler

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