Talking with your partner about ED, and what partners ask

In short: erectile dysfunction (ED) happens to a man, but it is felt by the couple. The research on partners shows they may notice the problem first, may worry that it is about them, and can influence whether help is sought and whether treatment sticks. That is why the American Urological Association (AUA) and the European Society for Sexual Medicine (ESSM) both recommend including a willing partner in assessment and treatment decisions (AUA guideline; Dewitte et al., ESSM, 2021). This page is written for both sides of that conversation: the man who wants to raise it, and the partner who wants to help.

How do you start the conversation about ED?

Choose a calm, private moment when neither of you is rushed, name what has changed in plain words, and make clear it is a health issue you want to deal with together. There is no single right script, so treat the points below as a starting place rather than a formula. What the evidence does show is that silence has costs: the ESSM notes that men tend to ignore or suppress the problem even when distressed, that a partner may notice it first, and that communication problems between partners, embarrassment and self-blame or partner-blame are among the barriers that can keep men and their partners from seeking help (Dewitte et al., 2021).

A few things the research suggests are worth saying out loud:

• What it is. ED is a common medical problem with many possible causes, and the AUA asks clinicians to tell men it can be a marker for heart disease and other conditions that may need a check (AUA guideline).
• What it is not. It is not a verdict on your partner. The ESSM notes that partners may start to doubt themselves when things change, so saying this directly can head off a worry they may not voice.
• What you plan to do. For example, booking a checkup, and asking whether they would like to be part of that.

The ESSM describes the communication skills couple-focused therapy works on: talking openly about what the ED means to each of you, what a satisfying sex life would look like for you both, and how any treatment would fit into it (Dewitte et al., 2021). Those are reasonable topics for a first conversation too, and it does not have to cover everything at once.

What do partners often worry about?

Many of the worries partners describe are about themselves: that they are no longer attractive, that they did something wrong, or that something else is going on. The ESSM position statements report that ED can cause trust issues for partners who read an erection as a sign of attraction, that partners may doubt themselves or suspect infidelity, and that ED may leave a partner feeling unattractive, guilty or rejected, with knock-on effects on the relationship and on their own sexual function (Dewitte et al., 2021). Partners may also be going through their own changes with age, menopause or illness, which the ESSM notes can affect sexual recovery.

Surveys of couples show the effect is real but usually shared. In the FEMALES study of 293 female partners of men with ED, women reported less frequent sexual activity and less satisfaction with their sexual relationship after ED began, and the drop in their satisfaction was linked to how severe the man rated his ED (Fisher et al., J Sex Med, 2005). A survey of 1,009 midlife and older couples in five countries found that men’s sexual problems were associated with lower relationship happiness and sexual satisfaction for both partners (less so for the women than the men), but the links were modest, and these long-term couples reported relatively high levels of affection overall (Rosen et al., Arch Sex Behav, 2016). These are associations from surveys, not proof of cause in any one couple.

Does ED mean my partner is no longer attracted to me?

Not on its own. ED has many causes: NIDDK lists diseases and conditions that affect blood vessels, nerves or hormones, many common medicines, lifestyle habits, and mental or emotional issues such as anxiety, depression, stress and low self-esteem (NIDDK, Symptoms and Causes of ED). The ESSM is balanced on the relationship side: ED clearly affects a couple, and existing communication problems or conflict can make it harder to cope with, but those factors are part of a wider picture rather than a single explanation (Dewitte et al., 2021). Only a clinical assessment can sort out what is behind it for a particular man. If anxiety seems to play a part, our guide to telling ED and performance anxiety apart explains the clues clinicians look at.

Can a partner come to appointments?

Yes, if you both want that, though going alone is also completely normal. NIDDK notes that during diagnosis a clinician may ask your intimate partner questions about your relationship and how it affects your ED, and that a counselor may ask you to bring your partner to sessions for more support (NIDDK, Diagnosis of ED; NIDDK, Treatment for ED). The AUA guideline says its panel strongly advocates inviting a man’s partner into the decision process whenever possible and clinically appropriate, and the ESSM recommends involving the partner in assessment when possible (Statement 6, Level 1, Grade B).

The ESSM explains why: a partner often knows more about the circumstances in which the ED happens, and may help motivate treatment (Dewitte et al., 2021). For what to say and bring to the visit itself, see our guide to talking to a doctor about ED.

How can a partner help?

Mostly by being informed, involved in decisions and patient about the pace. The ESSM reports that a partner’s attitude to and understanding of ED influences whether a man seeks treatment, that partner insistence is one of the indicators for seeking it, and that agreement between partners about the treatment choice predicts outcome and adherence. It also says positive partner involvement helps resolve the problem and keep treatment on track (Dewitte et al., 2021).

In practice, that can look like:

One finding is worth knowing for the long run. The ESSM cites research that more than half of couples stop using medical aids for erectile function after the first year, with possible reasons including cost, side effects, loss of spontaneity, new performance demands, unrealistic expectations and relationship issues (Dewitte et al., 2021). Talking about how treatment is going, not just whether it works, can help. If worry about how things will go has become part of the problem, our guide to working through performance anxiety covers the approaches with the most support.

Do partners need support too?

Often, yes. The ESSM recommends including the partner in ED treatment not only to support adherence and success but also to address the partner’s own psychological and sexual concerns and distress (Statement 16, Level 2, Grade B), and it notes that partners may need counseling in their own right (Dewitte et al., 2021). The same statements report that ED treatment has been shown to improve the partner’s sexual function and satisfaction as well. In the FEMALES survey, women whose partners were currently using a PDE5 inhibitor (the class that includes sildenafil and tadalafil) were more likely to report desire, arousal and orgasm most of the time, an association rather than proof that the medicine caused it (Fisher et al., 2005).

How do couples choose an ED treatment together?

By hearing the full set of options and deciding with the clinician what fits both of you. NIDDK says choosing an ED treatment is a personal decision and that, if you have a partner, you may want to talk together about treatments that work for you as a couple (NIDDK, Treatment for ED). The AUA builds its guideline on shared decision-making: men should be told about every option that is not medically ruled out, any of them can be a valid first choice, and the clinician’s role is to make sure the man and his partner fully understand the benefits, risks and burdens of each (AUA guideline). The ESSM makes the same point in its Statement 12 (Level 2, Grade B). For an overview of what those options are, see our guide to ED treatment options.

Couples do not always see things the same way. A study that compared the answers of men with ED and their female partners found they agreed closely on most points, including what the problem looked like, its effect on the relationship and attitudes to medicine, but it also identified specific points where they differed, which the authors say may contribute to avoiding treatment or to conflict (Fisher et al., J Sex Med, 2009). Saying your preferences out loud, rather than assuming, is part of the process.

A note on who the research covers

Most of the studies on ED and partners involve heterosexual, monogamous couples, and the ESSM cautions that the findings are not simply generalizable to other relationship types or to LGBTQI+ couples. It also notes that men who have sex with men may face added pressures such as sexual minority stress and stigma (Dewitte et al., 2021). The core advice, to talk openly and get a proper assessment, applies to everyone, including men who are not in a relationship right now.

When to talk to a clinician

Talk to a clinician if erection problems keep happening, if they are causing worry or strain between you, or if either of you is starting to avoid intimacy because of them. A clinician can look for physical causes, review medicines and discuss every suitable option; do not stop a prescribed medicine on your own (NIDDK, Treatment for ED). If mood, anxiety or the relationship is a big part of the picture, ask about a referral to a mental health professional, which the AUA says should be considered for men being treated for ED to help with treatment adherence, performance anxiety and fitting treatment into the relationship (AUA guideline).

Sources

• American Urological Association, Erectile Dysfunction Guideline: purpose statement, shared decision-making, inviting the partner into decisions, ED as a risk marker, Statement 6 on referral to a mental health professional.
• NIDDK, Treatment for Erectile Dysfunction, last reviewed October 2024: treatment as a personal and couple decision, partner in counseling, not stopping medicines on your own.
• NIDDK, Diagnosis of Erectile Dysfunction, last reviewed October 2024: clinicians may ask an intimate partner about the relationship.
• NIDDK, Symptoms and Causes of Erectile Dysfunction, last reviewed October 2024: the range of physical, medicine, lifestyle and emotional causes.
• Dewitte M et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med. 2021;9(6):100434: partner worries, barriers to seeking help, partner involvement in assessment and treatment (Statements 6, 8, 12 and 16), adherence, communication, limits of the research.
• Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erectile dysfunction: the FEMALES study. J Sex Med. 2005;2(5):675-684.
• Fisher WA, Eardley I, McCabe M, Sand M. Erectile dysfunction (ED) is a shared sexual concern of couples I: couple conceptions of ED. J Sex Med. 2009;6(10):2746-2760.
• Rosen RC, Heiman JR, Long JS, Fisher WA, Sand MS. Men with Sexual Problems and Their Partners: Findings from the International Survey of Relationships. Arch Sex Behav. 2016;45(1):159-173.