Restoring the sexual relationship after sexual dysfunction

In conjunction with restoring the man's erections, there will likely need to be some adjustments in the relationship. This is because over the months or years the partners may have become accustomed to avoiding intimacy and sexual relations. Some important points to keep in mind are outlined below. Also, it's worth remembering that men often have higher sex drives than women, and that women are often intimacy-driven rather than sex-driven.

  • Many women cherish the non-intercourse aspects of sex. So, even though the man's ability to have intercourse is restored, it's important to include the aspects of sexual activity that women appreciate. Lack of such attention can cause distress and even resentment. This is especially important in the case of men who are using Prostaglandin E1, which creates an "instant erection" without the physical need for sexual stimulation.
  • For some women, living without sexual activity with a partner for several months or years results in a gradual loss of their need to be sexual. Restoration of the man's erection does not restore the woman's sexual desire - indeed, she may be quite content with the status quo.
  • However, she will often "re-adapt" to being sexually active with her partner again if she's given time to reflect on the fact that their emotional intimacy will likely improve if sexual times are again possible, and if she can be assured that she will also be given the type of physical stimulation she needs (it may not be intercourse itself).
  • The majority of couples troubled by erectile dysfunction are older. After menopause, women who do not use (or have discontinued) estrogen replacement therapy may not be aware that their vagina has become dry. Once intercourse is restarted, they may be dismayed by the pain and discomfort that they are experiencing.
  • A product such as Replens contains no active medication, and restores moisture, elasticity, and healthy acidity to the vagina. The woman can also use a form of estrogen that acts mainly on the vagina, not the rest of the body. This can be obtained as a cream applied to the vagina, or as an estrogen "ring" placed high in the vagina by the woman.
  • Sometimes partners see the erectile dysfunction as the logical consequences of their not getting along well - they have noted their partner still awakens from sleep with a perfectly firm erection. They see the solution as getting help for the relationship - not as a medication for firming up the penis. If both partners are interviewed, these ideas can be pursued - this is less likely if only the one partner is seen.
  • Sex needs to be not only painless when it's restored, but pleasurable. If this isn't happening for the woman, she, too, can seek help from a physician or therapist.
  • Whichever medication or preparation is used to restore erections, both the partner and the relationship will benefit from understanding how the particular medication works. For example, with Viagra, it is especially important for the partner to realize that the medication works only when there is sexual arousal. With either of the preparations of Prostaglandin E1, the couple must realize that they must arouse each other to enjoy the erection.
Rosemary Basson, MD 
in association with the MediResource Clinical Team