Couple's Sexual Function
By definition, a couple is two persons considered together. As such, optimizing a couple’s sexual health requires addressing the sexual function of both individuals, as the sexual function of one partner will impact the sexual health of the couple. A comprehensive approach to the couple addresses both male erectile dysfunction (ED) and female sexual dysfunction (FSD).
Male Erectile Dysfunction (ED)
Erectile dysfunction (ED), previously referred to as “impotence,” is defined as a man’s inability to gain or maintain an erection adequate for the completion of intercourse. In the past, ED was considered a psychological disorder. It is now understood that ED is not “all in your head,” and in fact, may be a symptom of underlying cardiovascular disease and the earliest sign of heart disease. As American men have a 50% chance of dying of cardiovascular disease, ED should not be ignored by the patient, partner, and/or physician.
ED is a common problem as it afflicts approximately 30 million men in the United States. The incidence of ED increases as a man ages, so that 40% of men in their 40s, 50% of men in their 50s, 60% of men in their 60s, and 70% of men in their 70s, experience ED.
There are many causes of ED, including blood vessel abnormalities, hormonal imbalances, medication, previous surgery, neurologic disease, among others. The first step is to get medical attention and advice from a qualified urologist. In addition to a thorough history and physical examination by your physician, the following diagnostic tests may be utilized to determine the specific cause(s).
Questionnaires – self-administered questionnaires are commonly used to obtain baseline information on sexual function. One of the most common questionnaires is called the International Index of Erectile Function (IIEF).
Nocturnal penile tumescence (NPT) – determines the occurrence of erections during REM (rapid eye movement) sleep. Normally erections occur 1-5x/night and last 20-30minutes.
Ultrasound penile doppler flow studies - measures flow of penile blood vessels.
Vasoactive medication stimulation test – determines penile arterial and smooth muscle response to a drug (prostaglandin E1) injected into the penis.
Blood tests – screens for medical conditions which may impact erectile function, such as diabetes, high cholesterol, and low testosterone levels.
Cystoscopy – a lighted telescope is placed through the penis to check for enlarged prostate that may cause blockage of the urethra (tube that you urinate through).
There are several treatment options for ED.
Oral Therapy
Viagra (sildenafil citrate), introduced in 1998, was the first oral therapy available for ED. About 65% of all men with ED will respond to Viagra. There are other available oral therapies; specifically, Cialis (tadalafil) and Levitra (vardenafil), with similar mechanisms of action, but with differences in onset of action, length of action, and side effect profile. However, all the oral therapies cannot be taken by patients who require a certain class of medicines (nitrates) for heart disease, as life-threatening lowering of blood pressure can lead to death.
Vacuum Erection Device (VED)
The device is a mechanical, nonsurgical method of filling the penis with blood based on the principle that an erection can be produced by placing the penis in a vacuum chamber or cylinder which draws blood into the erectile tissue of the penis. Air is removed from the cylinder by a pump, drawing blood into the penis. The erection is maintained by trapping the blood in the penis by using a tight elastic band around the base of the penis.
Medical Urethral System for Erection (MUSE)
MUSE is an intraurethral therapy where a drug is placed in and absorbed through the urethra (tube that you urinate through).
Penile Injection
Medication that dilates blood vessel to the penis (arteries) and relaxes the smooth muscle of erectile chambers is injected into the penis to cause an erection.
Penile Implant
A penile implant is a device that is surgically placed within the penis and allows an erection “on demand.” There are 2 types of implants available: non-inflatable and inflatable prostheses. The non-inflatable product is less desirable due to varying degrees of concealment and a greater rate of medical complications compared to the inflatable implant. The inflatable penile implant is the most successful imitation of a natural erection that currently exists. Currently, the “gold standard” of penile implants is the three-piece inflatable prosthesis, as it offers the best ratio of mechanical reliability and patient satisfaction. The three-piece implant consists of 2 cylinders in the penis, a pump in the scrotum and a fluid-filled reservoir located behind the pubic bone. The entire device is implanted through a one inch incision. When an erection is desired, the patient squeezes the pump implanted into his scrotum, which pumps sterile saline from the reservoir into the penile cylinders. An erection develops which can be maintained as long as desired. When the erection is no longer desired, the release valve is pressed and fluid is transferred back into the reservoir. The surgery is very safe, relatively complication-free, and patients enjoy a 5-year success rate of 86%. As such, patient satisfaction is highest of any presently available treatment option for ED.
The other half of the management of the couple’s sexual function is the partner. If the partner is female, assessment and treatment of female sexual dysfunction is critical to optimization of the couple’s sexual health. Please see female sexual dysfunction for more information.
A comprehensive approach to the diagnosis, evaluation, and treatment of the couple’s sexual health involves addressing both partners, including a complete medical evaluation and psychological assessment. The Center for Sexual Health offers a multifaceted, team approach to a couple’s sexual health, as it incorporates medical assessment by board-certified urologist, individual and couples’ counseling by a licensed therapist, and pelvic rehabilitation from a trained physical therapist, for both partners of the couple.
