Erectile Dysfunction: A Guide for Couples Seeking Help

Sexual dysfunction

Hello Doctor: My husband has been experiencing erectile dysfunction for the past year, with a very short duration of erection that returns to its flaccid state before sexual intercourse, making it difficult for us to engage in sexual activity.
He is 33 years old and previously had a normal sexual life, with three to four sexual encounters per week and good stamina.
He has no underlying health issues, does not drink alcohol, and quit smoking two years ago.
Over the past two years, he has gained 15 kilograms, but his irregular night shift work has left him physically exhausted after work.
We had a pregnancy in the past before we were married, but we did not carry the child to term.
Now, we really want to have a baby, but due to this issue, he tends to avoid intimacy, feeling inadequate, and I also feel reluctant, so we hardly have any sexual activity—sometimes going two months without it.
Even when we do engage in sexual activity (with successful ejaculation), it is only during the ovulation period, and we only manage to do it once or twice, which may be too infrequent or the ovulation timing may be inaccurate, leading to difficulties in conceiving.
Although we are eager to have a child, I have been unable to bring myself to suggest that he seek medical help, considering his self-esteem.
Doctor, are there any tests that can be done jointly as a couple? This way, it would not be specifically targeting him, which might help preserve his self-esteem.
Additionally, based on the description, is this situation serious? Should we consult a urologist or an infertility clinic? Thank you.

Xiao Xiao, 20~29 year old female. Ask Date: 2005/06/05

Dr. Xu Weikai reply Urology

Hello, based on your description, I initially suspect that your husband may be experiencing erectile issues due to psychological stress.
In daily life, the need to work late and overtime, along with a weight gain of 15 kilograms, could indicate that he is under significant pressure and responsibility, which affects his physical health.
During his free time, he tends to watch TV and eat, rather than going outside for a walk or exercising.
This psychological burden, combined with long-term physical strain, has likely raised alarm bells.

Of course, this is just my personal conjecture; perhaps your husband is a high-tech professional who is affluent but lacks quality of life.
Regardless, if life is chaotic, normal semen production is unlikely to occur.
There is a saying: "When one is well-fed and warm, desires arise," meaning that reproductive capabilities emerge only when basic needs are met.
Reproduction is not a priority for survival; when life feels threatened, the body may sacrifice non-essential functions temporarily to cope with the crisis.
In simpler terms, stability in life and a lack of threats to survival are necessary for reproductive functions to resume.
Generally, when facing infertility issues, both partners are advised to undergo testing.
However, since male testing is simpler, semen analysis is typically conducted first to rule out any issues.
If there are no problems, the female partner is then tested.
If both are clear, further investigation may be needed to assess any potential incompatibility between the two.
I am not familiar with your specific situation, but I have encountered many similar cases.
My advice is straightforward yet challenging to implement: take a long vacation, as this may help restore normalcy.
In fact, some couples have conceived after returning home from a trip.
Consider how long it has been since you last took a break.

Note: When I refer to a long vacation, I suggest at least two weeks, ideally starting around the time of ovulation after the break.
If that is not feasible, I believe you need to communicate openly with your husband and support him through this period.
After all, declining health can lead to psychological stress, which in turn affects sexual function.
Occasional erectile dysfunction, especially in someone who is introverted, responsible, and self-critical, can lead him to internalize the pressure of perceived failure.
Therefore, I think you should help him and reassure him that this situation is not insurmountable.
Only when he regains his confidence will he experience better erectile function.
My recommendations are:
1.
If possible, take a vacation.
2.
Undergo a health check-up to rule out other conditions, such as diabetes or cardiovascular diseases.
3.
Communicate openly to help him rebuild his confidence.
Urology Department Chief, Hsu Wei-Kai
Response from Taitung Hospital, Department of Health, Executive Yuan
Caring for you.

Reply Date: 2005/06/05

More Info

Erectile dysfunction (ED) is a complex issue that can significantly impact both partners in a relationship, especially when there is a desire to conceive. Your husband's situation, where he has experienced a decline in erectile function over the past year, is not uncommon, particularly in younger men. At 33, the sudden onset of ED can be distressing and may stem from various factors, including psychological stress, lifestyle changes, and physical health issues.

Given the context you provided, it seems that several factors could be contributing to your husband's erectile dysfunction. The weight gain of 15 kilograms over the past two years, coupled with irregular work hours and physical exhaustion, can affect hormonal balance and overall energy levels, both of which are crucial for sexual function. Additionally, psychological factors such as anxiety about performance, especially in the context of trying to conceive, can exacerbate the situation. The pressure to perform can create a cycle of anxiety and avoidance, leading to further difficulties.

In terms of seeking help, it’s essential to approach this delicately, considering your husband's feelings and self-esteem. One effective way to encourage him to seek medical advice is to suggest a couple's health check-up. This can be framed as a proactive step for both of you, rather than singling him out. Many clinics offer comprehensive assessments for couples, which can include evaluations for fertility, hormonal levels, and sexual health. This approach can help alleviate any stigma he might feel about seeking help for erectile dysfunction.

As for the specific medical specialties to consult, both urology and reproductive endocrinology (the field that deals with infertility) can provide valuable insights. A urologist specializes in male sexual health and can assess for any underlying physical causes of ED, such as hormonal imbalances, vascular issues, or nerve damage. On the other hand, a fertility specialist can evaluate both partners to determine if there are any reproductive issues contributing to the difficulty in conceiving.

In terms of tests, a urologist may recommend blood tests to check hormone levels (like testosterone), a physical examination, and possibly a psychological evaluation if stress or anxiety is suspected to be a contributing factor. For fertility assessments, both partners may undergo semen analysis for the male partner and various tests for the female partner to evaluate ovulation and reproductive health.

It’s important to note that erectile dysfunction is often treatable, and many men find relief through lifestyle changes, counseling, or medication. Encouraging your husband to speak openly about his feelings and concerns can also foster a supportive environment where both of you can address this challenge together.

In summary, while your husband's situation may seem serious, it is not uncommon, and there are many avenues for help. By approaching this as a couple and seeking joint evaluations, you can support each other in navigating this sensitive issue. Open communication, understanding, and professional guidance can pave the way for both improved sexual health and the possibility of conception.

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