At the end of the day, my priority is your health and well-being. Whether you're dealing with a complex urological issue or seeking advice on a sensitive matter, I am here to provide the expert care you need with the compassion and understanding you deserve.
Erectile Dysfunction in a Relationship — A Guide for Both of You
What ED does to a couple, why silence does its own damage, and what a couples-aware consultation actually looks like. By Mr G. Ollandini.
It is half past eleven on a Tuesday. The dishes are done, the dog has been let out, the last text from work has been answered. Your partner reaches for your hand on the sofa and you flinch — a small flinch, the kind you might not have caught a year ago, but now you both notice. They withdraw their hand. You don't say anything. They don't say anything. You watch the rest of the programme with eight inches of cushion between you that wasn't there last month.
Later, in bed, you both pretend to be tired. They turn their back. You turn yours. And in the dark, two people who love each other run two completely different stories about what is happening.
Your story: I'm broken. It's happened three times now. If I try and it doesn't work again I'll feel even worse. Better not to try.
Their story: He doesn't fancy me any more. Maybe it's the weight I've put on. Maybe he's met someone. Maybe he's just stopped loving me and doesn't know how to say it.
Neither of you is correct. And the misunderstanding between your two stories can, over time, do more damage to your relationship than the original problem ever did.
I see this in clinic almost every week. A couple comes in — sometimes only the man at first, sometimes both — and what brings them is rarely just an erection problem. It is the silence around the erection problem. It is six months of avoidance dressed up as tiredness. It is one partner reading the other's withdrawal as rejection, and the other reading the partner's anxious questions as pressure. It is two people who used to talk about everything and now cannot find the words for this one thing.
This page is for both of you. It is written for the man whose body is no longer reliably doing what it used to do, and it is written for the partner who has been trying to interpret his silence and getting more frightened every week. The clinical name for what you're going through is erectile dysfunction. The name for what is happening to your relationship is something different — and that is what this page is mostly about.
If you want a fast clinical guide to why erections fail in partnered situations specifically, that is on a separate page: why your erections fail with someone you care about. This one is about what the failure does to the two of you.
ED in a relationship is rarely one person's problem
Medical Evidence
[#1] European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Arnhem: EAU; 2024.
Source:UROWEB.ORG
[#2] Salonia A, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioğlu A, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie's Disease. Eur Urol. 2025 (online ahead of print).
PIF TICK accredited information
The Patient Information Forum is the UK membership organisation and network for people working in health information and support. The PIF TICK is the UK-wide Quality Mark for Health Information.
Author Mr Giangiacomo Ollandini Published 02 May 2026Last update 02 May 2026Next review 02 May 2028Version v1.0
This content has been produced for educational purposes and reflects current evidence-based practice. Although GGO Med Ltd is a private urology service, all patient information is compiled with the aim of being accurate, evidence-based, and free from commercial bias. If you feel this content does not meet that standard, we would welcome your feedback — please contact us here.
On AI use: AI assists with literature scanning, readability and compliance checks, and prose drafting. Final clinical decisions and content sign-off remain with the consultant. How I use AI.
Erectile dysfunction is treated, in most clinical settings, as a man's problem. The man is the patient. The man gets the prescription. The partner, if they exist at all in the consultation, sits in the waiting room.
This framing is incomplete, and the evidence base has moved on. Sexual function in a partnered relationship is a couple-level phenomenon — what some authors have called a "shared sexual concern". When something disrupts erection, both people are affected — and the way the partner responds to the disruption has a great deal to do with whether the relationship comes through it.
Here is what I see happen, almost predictably, when erectile dysfunction enters a relationship and is not talked about.
The first failure is shocking but contained. You both quietly agree it was a one-off — too much wine, too tired, a strange day. You don't discuss it.
The second failure is worse. You start to monitor yourself during sex, and the monitoring itself makes the problem more likely. Your partner notices something is wrong but doesn't know whether to bring it up. Neither of you does.
By the third or fourth month, avoidance has started. Initiating sex feels too risky; one of you goes to bed earlier, the other later. The silence has its own architecture now, and each of you is rehearsing your own private worst-case explanation in the dark.
This is a pattern I see repeatedly in clinic — what I'd call a silence-to-avoidance-to-distance cascade. The individual ingredients are documented in the couple-coping literature: communication avoidance predicts partner marital distress, and constructive communication is protective regardless of the underlying sexual function. The shape of the cascade as I describe it here is my own clinical observation. It has one important property: once it has run for a while, it can become more troublesome than the erection difficulty that started it.
The good news, if there is good news in this section, is that the cascade is not fixed. Talking about it rarely solves ED by itself — but it is often the first step that allows treatment to work.
One specific version of partnered ED — when erections work alone but fail with a new partner — has its own mechanism, mostly to do with sympathetic override and performance anxiety. I cover that pattern in detail on the partner-specific page. The relational dynamics on the rest of this page apply either way.
The Bodenmann Systemic Transactional Model treats relationship stressors as either "shared from the start" (a job loss affecting both partners' finances) or "spilling over from one to both" (one partner's health condition that becomes a stressor for the relationship). Erectile dysfunction is the second kind. The unaddressed dysfunction does not stay located in the man — it spills into communication, intimacy, and the partner's own emotional state.
Falconier and colleagues' 2015 meta-analysis (72 studies, more than 18,000 couples) found that how a couple copes together with stress predicts relationship satisfaction across cultures. Bodenmann, Ledermann and Bradbury showed specifically that unresolved everyday stressors predict the development of sexual problems within the relationship — not the other way round. So the relationship-stressor pathway is bidirectional: ED puts pressure on the relationship, and unresolved relationship stress increases the likelihood of further ED.
Badr and Carmack Taylor's prostate-cancer cohort, where ED is near-universal post-treatment, is the cleanest empirical demonstration of the cascade in action. Mutual avoidance of sexual discussion strongly predicted partner marital distress, regardless of the underlying erectile function. Mutual constructive communication was protective regardless of the underlying erectile function. The communication, not the erection, was the variable that mattered most for relationship outcomes.
My partner has ED — what should I know?
This section is for you, the partner, in your own words.
If the man you are with has started losing erections — sometimes, often, or always — and you have been quietly building a story about what it means, please read this carefully.
Here is what the clinical evidence says. The most likely explanations for what is happening are physiological, anxiety-related, medication-related, cardiometabolic, relational, or mixed — and much less often about attraction than partners fear.
In men under fifty, performance anxiety, everyday stress, sleep debt, alcohol, medication effects and early cardiometabolic disease are all common enough that they deserve proper assessment. In men over fifty it is more often the early signs of cardiovascular or metabolic disease. In a partnered context, the reasons it appears are layered. In clinic, loss of attraction is much less often the explanation than partners fear — but I do not dismiss it if the history points that way.
If your partner has stopped initiating, has been making excuses about tiredness, has been avoiding intimacy entirely — what you are most likely seeing is a man who is frightened of failing in front of someone he loves, not a man who has stopped loving you.
In the largest survey of women whose partners have erectile difficulties — more than 13,000 respondents — almost 80% had experienced their partner losing his erection. About one in seven had been blamed for it by him. The women who had been blamed reported shorter encounters, lower self-confidence, more worry, and a higher rate of relationship break-up. Many partners interpret withdrawal from sex as rejection, especially when nobody has explained the physiology — and this misreading of the situation is itself a clinical pattern that deserves treatment as much as the original dysfunction.
There are three concrete things you can do that are evidence-supported.
Bring the topic up clothed, not in bed, and not after a failed attempt — choose a calm moment.
Use "I" language about your own emotional experience ("I have been feeling pushed away") rather than "you" language about cause ("you don't fancy me any more").
Ask to come to the consultation. The clinical evidence on this is strong: when partners attend the consultation, treatment adherence is higher and outcomes are better.
A self-advocacy script for the conversation neither of you wants to have
You don't have to use these words. But this is the kind of conversation that, in my experience in clinic, tends not to make things worse — and other approaches sometimes do.
Setting: Not in bed. Not directly after a failed sexual attempt. Choose a sober, undistracted moment — a walk, the kitchen on a Saturday morning, a long car journey.
Opening: "There's something I want to talk about. It's been on my mind for a while. I don't want it to keep being something we both pretend isn't happening."
For the man: "What's been happening with my body when we try to have sex isn't because of you. I want you to know that first. It's been making me feel awful and I've been avoiding talking to you because I felt ashamed. I'd like us to figure out what to do together."
For the partner: "I have been worried something was wrong with us. I have been wondering if I was doing something wrong, or whether you'd lost interest in me. I'd like to understand what's happening, and I'd like us to deal with this as a couple rather than separately."
Practical close: "Can we agree to go and see someone about this together? I think it would help both of us."
The conversation is awkward. It is supposed to be awkward. Awkward conversations are less damaging than years of silence — and after the first one, the next ones are easier.
When the partner reads ED as rejection
The cascade is reversible at any point — and that is what this page is about
This misreading is one of the most important patterns to name, because it is so common and so avoidable.
When a man loses his erection, withdraws from intimacy, and stops initiating sex — and does not explain why — his partner does not have access to the physiological story. So the partner's brain does what brains do: it generates the most plausible story given the available information. And the most plausible story, more often than not, is some version of "he doesn't want me any more".
Here are four versions of that story I hear in clinic and that surface repeatedly in the qualitative literature on female partners.
"He's no longer attracted to me. There's something wrong with me — my body, my appearance, my age." What is most likely actually happening: his sympathetic nervous system is overriding his erectile response, often because of anxiety about failure. Attraction is not the variable.
"If I try harder — be more sexually adventurous, change how I look, initiate more — I can fix this." What is most likely actually happening: increased pressure makes the failure more likely, not less. The "fixing imperative" is one of the most common ways the cascade deepens.
"I will pretend it doesn't matter, to protect his ego." What is most likely actually happening: he hears the dismissal underneath. Repeated "it doesn't matter" feels invalidating to a man who is actually distressed about his body.
"If he can't get an erection with me, he must be getting them with someone else, or with porn." What is most likely actually happening: extreme pornography consumption can be a small contributor in some men. But the most common driver of partnered-only ED is anxiety, fatigue, or developing medical disease — not infidelity or porn.
If you recognise yourself in any of these stories — please understand that you are responding to a situation with incomplete information, not failing at being a partner.
The way out of all four mis-readings is the same: the man names what is actually happening with his body, the partner is given the physiological context, and the two of them stop interpreting each other's behaviour through the lens of a story that isn't true.
What I ask men about their partner's response — and what their answer tells me
There is one question I almost always ask in the first consultation, and the answer to it shapes everything that follows: "What has your partner said or done about this?"
I do not ask it to judge the partner. I ask it because the answer the man gives me is one of the most clinically informative pieces of the consultation. It tells me what he has noticed, what he has built up in his head about her response, whether resentment has been growing, and — by inference — what is most likely going on in the partner who is not in the room. In my own clinic, four partner responses come up again and again. They are not a published taxonomy. They are a pattern I have noticed, and each one points me toward a different next conversation.
"She doesn't mind. She might even prefer it this way." This is the answer that most concerns me, and I will follow it carefully. Sometimes it is genuine reassurance. Sometimes it is a clue that the partner may also have an unspoken sexual difficulty that has never been named — vaginismus, anorgasmia, low desire, pain, or sometimes a history of sexual trauma never disclosed. When I hear this version, I may be sitting with one half of a couple where both partners have an unaddressed sexual problem and neither has surfaced it. A relationship in which sex never really worked and quietly stopped being attempted, with both partners quietly relieved and quietly diminished — what an older clinical literature called a mariage blanc, a "white marriage". When I hear this answer, the next conversation is no longer just about him. It is about whether his partner has ever been properly assessed.
"She's furious. She's the one who sent me here." This often arrives as something the man finds upsetting, and on the surface it is. Underneath, anger is not ideal — but it may mean the problem still matters enough to be named. Clinically, I worry more about settled silence than about distress that is still being expressed. When the partner is angry enough to say so, she has refused to let the silence settle, and that refusal is the thing I am quietly grateful for in the consultation.
"We don't really talk about it." This is the answer that maps onto the cascade I described earlier on this page. The monsters are growing under the carpet. Each of you is rehearsing your own private explanation, and the longer the silence runs, the harder it becomes to introduce the topic without it feeling like an indictment. Most of the couples I see fall somewhere along this pattern. The work is to name it, gently and with help, before it ossifies.
"She tells me not to worry, that it's nothing." "It doesn't matter" is often meant kindly, but many men hear it as dismissal. To the man, it can feel invalidating — how can it be nothing when it is everything I think about? And the partner saying it is often not as comfortable as the words suggest. Behind "it's nothing" can sit a partner who is privately frightened — that he has met someone else, that he is leaving, that something is wrong that she does not know how to ask about. The reassurance is anaesthetic for both of them, and it is one of the things I try to interrupt as early as I can.
The reason I ask this question is not to assign blame. It is because the partner's response is not background noise — it is clinically informative. It tells me what kind of conversation we need to have next, what I should be alert to, and — often — whether there is a second person in this relationship who has been quietly carrying their own clinical problem for years.
If you recognise yourself in any of these four answers — either as the patient or as the partner — please understand that none of them are failures. They are situations. And every one of them has been in this consulting room before.
How I think about ED in clinic — the function of the dysfunction
You may have noticed, in the last section, that the questions I ask are not entirely standard. Before this section makes sense, you should know how I work.
The first thing I do in a consultation about erectile dysfunction is normalise. Not as a technique. As the baseline I hold throughout. There is no question I will judge you for asking, no detail about your sex life that I have not heard before, no preference or absence of preference that I will treat as strange. Without normalisation, men do not tell me the things I need to know — and without those things, I cannot do my job.
Alongside the standard "what is causing this?" question — vascular, hormonal, neural, psychogenic — I also ask a different one: what is this dysfunction now doing in your life or in your relationship? What might it allow you to avoid? What conversation might it be sitting on top of? What pattern might it conveniently delay?
I am not claiming the dysfunction exists in order to avoid those things — that would be a different argument and a less defensible one. I am saying that, in clinic, the dysfunction often turns out to be doing more than one job, and that naming the second job changes what we can do about the first. This is not urology pretending to be psychotherapy. I trained formally with the Institute of Psychosexual Medicine (IPM) and I am the andrology lead of the Psychosexual Service at King's College Hospital NHS Foundation Trust — which is where the second question came from, and where I have learnt to hold it alongside the first without confusing the two.
Two situations are exceptions to the no-judgement rule, and both are clinically important.
The first is when there is abuse — coercion, intimidation, sexual violence — disclosed by the patient or implied strongly enough that I would be negligent not to name it. When that happens, my job stops being neutral. I will say clearly that what is being described is not acceptable, not a normal part of any relationship, and we will discuss what supports exist. I do not interpret abuse with a curious eyebrow. I name it.
The second is when a man is being savagely hard on himself. Some men come into the consultation having already passed a verdict on themselves: that they are broken, useless, a failure as a partner, a failure as a man. They are not asking me whether the verdict is correct. They are asking me to confirm it. I will not. Gently but firmly, I push back — because the self-flagellation is itself a clinical pattern that gets in the way of the work. I will tell a man directly that the standard he is holding himself to is one no human body could meet, and that the shame he has been carrying is doing more damage than the dysfunction. That is not a softening. It is an intervention.
Bodies, partners, and the language of this page
I use "man" and "partner" for readability, and the hero scene at the top of this page reads heterosexual by default — but the underlying mechanisms (sympathetic override, dyadic coping, attachment patterns, communication avoidance) apply across sexual orientations, gender histories and relationship structures. Some details change with anatomy, hormones, surgery and relationship agreements; the principles do not.
A few specifics I see in clinic and that the accordions below address in depth.
Same-sex male couples sometimes carry extra pressure around sexual roles and around post-prostate-cancer transitions in receptive role. Trans women on feminising hormone therapy reliably experience reduced erectile function — welcome for some, a clinical concern for others, and both are legitimate consultations. Trans men on testosterone, post-metoidioplasty or post-phalloplasty have specific considerations I cover in detail because metoidioplasty is part of my surgical practice. Mixed-orientation transitions — coming out, leaving an existing relationship, moving between structures — frequently produce highly situational ED that points away from organic disease. Non-monogamous relationships often bypass the misreading-as-rejection mechanism, because the exclusivity frame that fuels it is absent.
The published evidence on erectile change in non-binary or gender-fluid people is essentially absent — that is an evidence gap, not a clinical irrelevance — and I discuss specifics in consultation.
The clinical mechanisms are the same as in heterosexual partnered ED, with two MSM-specific layers worth flagging. First, transient erectile difficulty in the hours or day after receptive anal intercourse is common and is most often pelvic-floor fatigue — not nerve damage, and not a sign of underlying disease. Second, "the top must always be erect" is a script some MSM patients have internalised; in clinic I see this pattern produce performance anxiety more reliably than almost any other dynamic. After prostate-cancer treatment, a meaningful proportion of gay men shift from a top role to a bottom role or stop having anal sex altogether — this is a clinically real adjustment that benefits from being named and worked through, not minimised.
Pelvic-floor fatigue after receptive anal intercourse is well-described and is the most common reason for transient erectile difficulty in the hours or day following. It is not a sign of nerve damage from anal sex — that is a myth and the evidence does not support it. After radical prostatectomy, the biomechanics of anal sex change significantly: prostate sensation is lost, the anatomy is altered, and a meaningful proportion of gay men either shift role to bottom, become exclusively non-penetrative, or stop having anal sex altogether. Ussher and colleagues' study of 124 gay and bisexual men with prostate cancer documents this pattern in detail. For some men this is a clinically manageable role transition; for others it is a substantive identity loss that needs to be named and worked through, often in psychosexual therapy.
Feminising hormone therapy in trans women reliably reduces both spontaneous and elicited erections. Some patients are content with this change; others find that erectile function remains important, either for their own sexual experience or for their partner's, and want to address it.
Phosphodiesterase-5 inhibitors are sometimes used in this population, with variable response — testosterone suppression reduces the substrate the medications work on. Intracavernosal alprostadil is an off-label option that some patients use; this is a real clinical use case in trans women who have retained their original anatomy and want reliable rigidity for sexual activity.
The clinical decision is highly individualised. If this is relevant to you, bring it to the consultation — it is one of the conversations I have most weeks.
This is part of what I do clinically — I lead the metoidioplasty service at the Chelsea Centre for Gender Surgery, and sexual function is one of the things I think about most.
Testosterone in trans men produces clitoral hypertrophy, often substantial in the first year, with corresponding changes in erectile sensation and response. Sexual function is broadly improved by testosterone in most patients, with the caveat that vaginal or frontal-genital-opening discomfort is a commonly reported finding (around two-thirds of trans men on T in one large analysis). This is not the same as erectile dysfunction — but it sits alongside it as something worth raising in clinic.
After metoidioplasty, the neophallus contains erectile tissue capable of natural rigidity, but is typically too short for penetrative intercourse without aids. PDE-5 inhibitors — most commonly tadalafil — are used off-label in selected cases. The evidence base for this practice is limited; in my own practice I am explicit with patients that the response is partial and the data are thin. I do not use intracavernosal injections in metoidioplasty anatomy. Vacuum-based devices exist commercially and are used by some patients; the evidence base, again, is limited. After phalloplasty, the constructed phallus does not contain native erectile tissue, and rigidity for penetration requires either an internal prosthesis or an external aid; complication rates are non-trivial.
Trans men in non-heterosexual relationships — gay, queer, polyamorous, or otherwise — are a meaningful proportion of my CCGS practice, even though the published clinical literature on this specific combination is essentially absent. ED in cis men with trans partners has, to my knowledge, no specific peer-reviewed clinical literature; the dual-control and cognitive mechanisms most likely apply, with the additional complexity of how the cis man processes his own attraction. If any of this is part of your situation, it is part of what I do.
If you are coming out, leaving a mixed-orientation marriage, or moving between relationship structures, ED can be highly situational — reliably absent in some contexts, reliably present in others. Diagnostically that pattern is helpful: it almost always points away from organic disease.
The complications here tend to be identity-related rather than physiological. Performance anxiety in a new sexual context is real, and the partner who is "left behind" in a coming-out transition is at high risk of misreading the new ED as rejection — with an additional layer of identity-related grief on top. The evidence base on this combination is qualitative and clinical rather than epidemiological. The principles in the rest of this page still apply.
When to come to consultation together
This is one of the things I am most direct with patients about: if you are in a partnered relationship and the ED is affecting both of you, please come to the consultation together — when the relationship is safe and both of you want to be involved.
The clinical literature on this is consistent. Treatment adherence is higher when partners are involved in the decision. Treatment satisfaction is higher when partners are part of the conversation. Combined medication-plus-couple-therapy outperforms medication alone for couple-level outcomes. None of this applies if the relationship is coercive, abusive, or so conflicted that bringing the partner into the room would make the consultation unsafe — in those situations, individual consultation first is the right move.
The structural reality is that the NHS pathway for ED is not designed to accommodate the partner. The consultation is between the man and the GP, the consultation is short, there is no mechanism for partner inclusion, and the prescription is generic sildenafil. This is not a criticism of GPs — it is a criticism of the consultation slot length they are given. But if you want a couples-aware approach, you generally have to look outside the standard pathway.
What a couples-aware consultation actually looks like, for what it's worth: I take the history with both of you in the room. Both partners get to say what the situation is from their side. Both partners get the same physiological explanation — so the partner is no longer interpreting the man's body without information. I am explicit about treatment options and about what each option will and won't do. The partner is invited to ask questions, and in practice, partners often ask questions that change the consultation.
If you'd rather come alone first, that's also fine — many patients do, and bring the partner to the second appointment when there is something concrete to discuss.
The consultation is structured to make the partner an actual participant, not an observer. We take a joint sexual history. Both partners get space to describe the situation as they see it — which often differs in informative ways. We assess cardiovascular and metabolic risk factors (essential — ED in men under 50 is a strong cardiovascular risk marker, and we screen properly). We discuss treatment options at the couple level rather than the individual level. We agree a plan that both of you are signed up to, because adherence is a couple-level decision in the data and we treat it accordingly.
If psychosexual or relationship therapy is indicated alongside the andrological work, I refer to a COSRT-registered psychosexual therapist — and I run the andrological work-up in parallel rather than after.
What well-meaning advice often gets wrong
Three pieces of common advice come up in clinic and are often, mechanistically, the wrong move.
Common advice that backfires
Myth
Myth: "Just relax."
Fact
Fact: Relaxation cannot be dialled up on demand, and the instruction recruits self-monitoring — exactly the cognitive state that makes erection less likely. The clinical alternative is to shift attention away from outcome and onto sensation (Metz and McCarthy's "Good Enough Sex" model).
Myth
Myth: "Spice it up."
Fact
Fact: Novelty advice is for couples in low-arousal patterns who are otherwise fine. In an ED-driven avoidance cascade, adding novelty typically increases performance pressure rather than reducing it.
Myth
Myth: "It's the porn."
Fact
Fact: The scientific evidence on pornography and ED is genuinely mixed. Some men with problematic, compulsive use patterns experience ED that improves when they reduce use; in the population at large, pornography use itself does not show a causal link to ED. Reflexively blaming pornography is often a way of avoiding harder questions — about anxiety, about the relationship, or about silent cardiometabolic disease that should have been investigated.
One further anti-pattern — buying PDE-5 inhibitors from unauthorised websites or social media — is covered separately on the ED assessment page and on the main hub. The short version is: don't. UK MHRA enforcement seized 19.5 million doses of unauthorised ED medicines between 2021 and 2025, and counterfeit tablets routinely contain the wrong drug, no drug, or contaminants.
When the relationship is the diagnosis
I sometimes use the phrase relational ED as a clinical shorthand — not as a formal diagnostic category — for ED that is highly specific to one relationship context. The proximate driver is not generalised performance anxiety, not novelty, not pornography, but the dynamic of this specific relationship. Chronic conflict, unresolved resentment, an undisclosed betrayal, eroticised hostility, an attachment rupture that has never been repaired.
The clinical signs that point this way are recognisable.
Morning and masturbatory erections are intact.
Failure is specific to this partner — erections may be reliable in solo masturbation or with other partners.
Onset coincides with an identifiable relational event — a betrayal, a major argument never properly resolved, a structural change in the relationship.
The patient describes loss of erotic feeling for the partner rather than loss of erectile capacity per se.
Even when the pattern looks relational, I still check the body properly. The old "physical or psychological" split is too crude — most ED is mixed, and missing a metabolic or vascular driver underneath a relational presentation is exactly the kind of error this page is here to prevent.
When this is what is happening, a PDE-5 inhibitor on its own often does not do enough. Medication can help the erection. If the couple has reorganised itself around fear, silence or resentment, the medication alone may not repair the sexual relationship — and in some cases, the man returns saying the pill works mechanically while nothing has actually got better between him and his partner.
In these consultations I do not treat psychosexual therapy as a fallback when medication has failed. I bring it up early — because I have already worked out, with the patient and where possible with the partner, what is most likely going on. I am not sending anyone "off to the psychosexual therapist to see if they can figure it out". I am sending people to a colleague who works on a particular piece of the picture more deeply than I can, with a working hypothesis we have already shared. The andrological work-up runs in parallel, not afterwards.
The evidence base on this is good. Psychological interventions improve ED outcomes; combined medication plus couple sex therapy outperforms medication alone for couple-level outcomes; brief couple sex therapy added to sildenafil produces better couple satisfaction than sildenafil alone. The treatment is not "less medical" because it is psychosexual — it is differently medical, and for some men it is the primary indication.
In the UK, the College of Sexual and Relationship Therapists (COSRT) holds the public register of qualified psychosexual therapists, and is the route I most often use. Relate is the other commonly used pathway, primarily for relationship-focused (rather than psychosexual-focused) work. The Institute of Psychosexual Medicine (IPM) is a third route, for medical practitioners trained in psychosexual medicine specifically.
What I still check medically
Even when ED looks relational, I still assess the body. The pattern of erections (morning, masturbatory, partnered), current medications, alcohol and substance use, blood pressure, fasting glucose or HbA1c, lipid profile, and a morning total testosterone are part of the standard work-up — and selected further tests when they would change the plan. The relationship may be the diagnosis, but the body is never an assumption.
If you're reading this together
If you have read this far, and especially if you have read this far together, you have already done one of the harder things this page asks of you.
Three concrete things you can do this week, before the next sexual encounter.
Have the conversation, clothed, somewhere that isn't the bedroom. Use the script in the inline-expand earlier on this page, or use your own words. The conversation is awkward. It is supposed to be awkward. The silence is doing more damage.
Stop interpreting each other's bodies without information. The man is most likely not rejecting the partner. The partner is most likely not the cause. The body is not failing because the relationship has failed. Get the physiological information first, and let it correct the misreading.
Book one consultation, together if at all possible. A proper assessment with both of you in the room reframes the problem from "his to fix" to "ours to address" — and the evidence on partner involvement and communication supports that direction.
And if the conversation goes badly the first time — if it gets defensive, or shut down, or harder than you hoped — that is also information. The path through is the same: keep the misreading from settling, get the physiological context out into the open, and bring the two of you to a room where the problem can be addressed together. The work is harder when the silence has been long. It is not less reachable.
Book a couples-aware consultation
A proper history, a proper work-up, and both of you in the room. The way ED in a relationship should be assessed.
Usually, no. ED in a partnered relationship is much more often linked to anxiety, fatigue, stress, medication, alcohol, relationship pressure, or a medical issue that should be assessed. Loss of attraction can happen, but it is not the first explanation I assume. The misreading of his withdrawal as rejection is one of the most common — and most damaging — patterns in this situation.
Yes — and not just indirectly. I sometimes use the phrase relational ED as a clinical shorthand (not a formal diagnosis) for ED where the proximate driver is the relationship dynamic itself: chronic unresolved conflict, undisclosed infidelity, an attachment rupture, or sustained resentment. The clinical signs are intact morning and masturbatory erections, partner-specific failure, and an identifiable relational event preceding onset.
Yes, when the relationship is safe and both of you want to be involved. Partner involvement is associated with better treatment engagement and satisfaction, and the partner being part of the discussion reframes the problem from individual deficit to shared challenge. If your partner cannot or will not come to the first appointment, come alone and bring them next time — both options are fine.
Choose a calm moment, clothed, away from the bedroom. Use "I" language about your own emotional experience rather than "you" language about cause. Don't have the conversation directly after a failed sexual attempt. Keep it short — the goal is to open the topic, not to solve it in one conversation.
This is common, and it is most often driven by shame rather than indifference. The most useful intervention I have seen is the partner saying clearly: "I am worried about you and I want us to deal with this together. Will you come with me?" Reframing the consultation as "ours" rather than "yours" reduces the shame load significantly. If he still refuses, you can come for a partner-only consultation yourself — that is a real clinical option.
No — and the question itself is part of the problem. ED is a symptom, not a verdict. The way the relationship handles the ED matters more than the ED itself. Couples who keep talking about it, even badly, tend to come through it. Couples who allow silence to become avoidance and avoidance to become distance are the ones who get into difficulty — and the cascade is reversible at any point.
Sometimes — when the relationship was good and the ED has been the disruptor. Sometimes only partially — when the ED has been present long enough that the avoidance cascade has become its own problem. Sometimes not at all — when the relationship dynamic was the underlying driver of the ED. The honest answer is that medication is part of the answer in most cases and the entire answer in very few.
Yes. I see same-sex couples, trans patients and people in non-monogamous relationships in my urology and gender-affirming practice. The clinical principles are the same, but the details may change with anatomy, hormones, surgery history, sexual roles and relationship structure.
BSSM (British Society for Sexual Medicine) — patient resources
BAUS (British Association of Urological Surgeons) — patient information leaflets
MHRA #FakeMeds resource — for safe sourcing of erectile-dysfunction medication
[#3] Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, et al. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men—2017. J Sex Med. 2018;15(4):430–57.
[#5] Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200(3):633–41.
[#6] Dewitte M, Bettocchi C, Carvalho J, Corona G, Flink I, Limoncin E, et al. Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med. 2021;9(6):100434.
[#72] Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (WPATH SOC-8). Int J Transgend Health. 2022;23(Suppl 1):S1–S259.
[#80] Hackett G, Kirby M, Rees RW, Jones TH, Muneer A, Livingston M, et al. The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice. World J Mens Health. 2023;41(3):508–37.
[#88] Medicines and Healthcare products Regulatory Agency. Reclassification of sildenafil 50 mg (Viagra Connect) from POM to P. London: MHRA; 2017.
[#89] National Health Service Business Services Authority. NHS Drug Tariff, Part XVIIIB. Newcastle: NHSBSA; 2024.
[#90] Medicines and Healthcare products Regulatory Agency. Yellow Card Scheme.
Source:YELLOWCARD.MHRA.GOV.UK
[#92] Medicines and Healthcare products Regulatory Agency. MHRA and eBay remove unauthorised erectile dysfunction medicine listings (press release). London: MHRA; 2025.
[#105] Community Pharmacy England. SLS endorsement requirements removed for Tadalafil and Vardenafil from October 2025. London: CPE; 2025.
[#106] National Health Service England. Items which should not routinely be prescribed in primary care: a Consultation on Guidance for CCGs. London: NHS England; 2017.
[#107] Department of Health. Treatment for impotence. HSC 1999/115. London: DH; 1999.
[#9] Falconier MK, Randall AK, Bodenmann G, editors. Couples Coping with Stress: A Cross-Cultural Perspective. New York: Routledge/Taylor & Francis; 2016.
[#10] Bodenmann G, Ledermann T, Bradbury TN. Stress, sex, and satisfaction in marriage. Pers Relatsh. 2007;14(4):551–69.
[#11] Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M; MALES Study. The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20(5):607–17.
[#12] Fisher WA, Rosen RC, Eardley I, Niederberger C, Nadel A, Sand M; MALES Study. The multinational Men's Attitudes to Life Events and Sexuality (MALES) study Phase II: understanding PDE5 inhibitor treatment seeking patterns, among men with erectile dysfunction. J Sex Med. 2004;1(2):150–60.
[#13] 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):2746–60.
[#14] Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study. J Sex Med. 2005;2(5):675–84.
[#15] Fisher WA, Eardley I, McCabe M, Sand M. Erectile dysfunction (ED) is a shared sexual concern of couples II: association of female partner characteristics with male partner ED treatment seeking and phosphodiesterase type 5 inhibitor utilization. J Sex Med. 2009;6(11):3111–24.
[#16] Fisher WA, Eardley I, McCabe M, Sand M. Couple perceptions and attitudes towards erectile dysfunction: findings of the FEMALES study. Eur Urol Suppl. 2008;7(3):201.
[#17] Çayan S, Bozlu M, Canpolat B, Akbay E. The assessment of sexual functions in women with male partners complaining of erectile dysfunction: does treatment of male sexual dysfunction improve female partner's sexual functions? J Sex Marital Ther. 2004;30(5):333–41.
[#18] Öberg K, Fugl-Meyer AR, Fugl-Meyer KS. On categorisation and quantification of women's sexual dysfunctions: an epidemiological approach. Int J Impot Res. 2004;16(3):261–9.
[#19] Hendrickx L, Gijs L, Enzlin P. Female sexual dysfunction, sexual distress, and compatibility with partner. J Sex Med. 2016;13(4):597–605.
[#20] Dubin JM, Wyant WA, Balaji NC, Ong WL, Kettache RH, Haffaf M, et al. Is Female Wellness Affected When Men Blame Them for Erectile Dysfunction? Int J Impot Res. 2021;33(8):786–90.
[#21] Badr H, Carmack Taylor CL. Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psychooncology. 2009;18(7):735–46.
[#22] Granados R, Moyano N, Sierra JC. Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment. Sex Med. 2021;9(6):100459.
[#23] Brassard A, Dupuy E, Bergeron S, Shaver PR. Attachment insecurities and women's sexual function and satisfaction: the mediating roles of sexual self-esteem, sexual anxiety, and sexual assertiveness. J Sex Res. 2015;52(1):110–9.
[#24] Ciocca G, Limoncin E, Di Tommaso S, Mollaioli D, Gravina GL, Marcozzi A, et al. Attachment styles and sexual dysfunctions: a case–control study of female and male sexuality. Int J Impot Res. 2015;27(3):81–5.
[#25] Davis D, Shaver PR, Widaman KF, Vernon ML, Follette WC, Beitz K. 'I can't get no satisfaction': Insecure attachment, inhibited sexual communication, and sexual dissatisfaction. Pers Relatsh. 2006;13(4):465–83.
[#26] Mallory AB, Stanton AM, Handy AB. Couples' Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis. J Sex Res. 2019;56(7):882–98.
[#27] Andersson KE. Pharmacology of penile erection. Pharmacol Rev. 2001;53(3):417–50.
[#28] Steers WD. Neural pathways and central sites involved in penile erection: neuroanatomy and clinical implications. Neurosci Biobehav Rev. 2000;24(5):507–16.
[#29] Bancroft J, Janssen E. The dual control model of male sexual response: a theoretical approach to centrally mediated erectile dysfunction. Neurosci Biobehav Rev. 2000;24(5):571–9.
[#30] Janssen E, Bancroft J. The dual-control model: the role of sexual inhibition and excitation in sexual arousal and behavior. In: Janssen E, editor. The Psychophysiology of Sex. Bloomington: Indiana University Press; 2007. p. 197–222.
[#31] Janssen E, Bancroft J. The Dual Control Model of Sexual Response: A Scoping Review, 2009–2022. J Sex Res. 2023;60(7):948–68.
[#32] Bancroft J, Graham CA, Janssen E, Sanders SA. The dual control model: current status and future directions. J Sex Res. 2009;46(2–3):121–42.
[#33] Nobre PJ, Pinto-Gouveia J. Cognitive and emotional predictors of female sexual dysfunctions: preliminary findings. J Sex Marital Ther. 2008;34(4):325–42.
[#34] Nobre PJ. Psychological determinants of erectile dysfunction: testing a cognitive–emotional model. J Sex Med. 2010;7(4 Pt 1):1429–37.
[#35] Carvalho J, Nobre P. Biopsychosocial determinants of men's sexual desire: testing an integrative model. J Sex Med. 2011;8(3):754–63.
[#36] Nobre PJ, Pinto-Gouveia J. Cognitive schemas associated with negative sexual events: a comparison of men and women with and without sexual dysfunction. Arch Sex Behav. 2009;38(5):842–51.
[#37] Tavares IM, Moura CV, Nobre PJ. The Role of Cognitive Processing Factors in Sexual Function and Dysfunction in Women and Men: A Systematic Review. Sex Med Rev. 2020;8(3):403–30.
[#39] Metz ME, McCarthy BW. The 'Good-Enough Sex' model for couple sexual satisfaction. Sex Relatsh Ther. 2007;22(3):351–62.
[#40] Conaglen HM, Conaglen JV. The impact of erectile dysfunction on female partners: a qualitative investigation. Sex Relatsh Ther. 2008;23(2):147–56.
[#41] O'Connor EJ, McCabe MP, Conaglen HM, Conaglen JV. Attitudes and experiences: qualitative perspectives on erectile dysfunction from the female partner. J Health Psychol. 2012;17(1):3–13.
[#42] Conaglen HM, Conaglen JV. Couples' reasons for adherence to, or discontinuation of, PDE type 5 inhibitors for men with erectile dysfunction at 12 to 24-month follow-up after a 6-month free trial. J Sex Med. 2012;9(3):857–65.
[#43] Conaglen HM, Conaglen JV. Couples' reasons for adherence to, or discontinuation of, PDE type 5 inhibitors for men with erectile dysfunction at 12 to 24-month follow-up after a 6-month free trial. J Sex Med. 2012;9(3):857–65. (Second-citation reference of [#42] in dossier — same source.)
[#44] Salonia A, Adaikan G, Buvat J, Carrier S, El-Meliegy A, Hatzimouratidis K, et al. Sexual rehabilitation after treatment for prostate cancer—Part 1 and Part 2: Recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2017;14(3):285–311.
[#45] Eardley I, Mirone V, Montorsi F, Ralph D, Kell P, Warner MR, et al. An open-label, multicentre, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in men naïve to phosphodiesterase 5 inhibitor therapy. BJU Int. 2005;96(9):1323–32.
[#46] Shindel AW, Vittinghoff E, Breyer BN. Erectile Dysfunction and Premature Ejaculation in Men Who Have Sex with Men. J Sex Med. 2012;9(2):576–84.
[#47] Shindel AW, Horberg MA, Smith JF, Breyer BN. Sexual dysfunction, HIV, and AIDS in men who have sex with men. AIDS Patient Care STDS. 2011;25(6):341–9.
[#48] Hart TA, Schwartz DR. Cognitive-behavioral erectile dysfunction treatment for gay men. Cogn Behav Pract. 2010;17(1):66–76.
[#49] McDonagh LK, Bishop C, Brockman M, Morrison TG. A systematic review of sexual dysfunction measures for gay men: how do current measures measure up? J Homosex. 2014;61(6):781–816.
[#50] Sheng Y. Psychological consequences of erectile dysfunction. Trends Urol Mens Health. 2021;12(6):24–7.
[#51] Allen MS, Wood AM, Sheffield D. The Psychology of Erectile Dysfunction. Curr Dir Psychol Sci. 2023;32(6):487–93.
[#52] Riley A. The role of the partner in erectile dysfunction and its treatment. Int J Impot Res. 2002;14 Suppl 1:S105–9.
[#53] Gottman JM, Levenson RW. The timing of divorce: predicting when a couple will divorce over a 14-year period. J Marriage Fam. 2000;62(3):737–45.
[#54] Gottman JM. The Seven Principles for Making Marriage Work. New York: Crown; 1999.
[#55] Berner M, Günzler C. Efficacy of psychosocial interventions in men and women with sexual dysfunctions—a systematic review of controlled clinical trials. J Sex Med. 2012;9(12):3089–107.
[#56] Christensen A, Heavey CL. Gender and social structure in the demand/withdraw pattern of marital conflict. J Pers Soc Psychol. 1990;59(1):73–81.
[#57] Aubin S, Heiman JR, Berger RE, Murallo AV, Yung-Wen L. Comparing sildenafil alone vs. sildenafil plus brief couple sex therapy on erectile dysfunction and couples' sexual and marital quality of life: a pilot study. J Sex Marital Ther. 2009;35(2):122–43.
[#58] Vansintejan J, Janssen J, Van De Vijver E, Vandevoorde J, Devroey D. The GAy MEn Sex StudieS: erectile dysfunction among Belgian gay men. Int J Gen Med. 2013;6:527–34.
[#59] Cherrez-Ojeda I, Vasquez-Calle JF, Vanegas E, Cherrez S, Cherrez A, Felix M, et al. Prevalence and associated factors of premature ejaculation and erectile dysfunction in young, single MSM in Lima, Peru. Sex Med. 2024;12(1):qfae014.
[#60] Ussher JM, Perz J, Kellett A, Chambers S, Latini D, Davis ID, et al. Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer. Arch Sex Behav. 2017;46(7):2043–57.
[#61] Pereira TJ, Machado PPP, Peixoto MM. Dysfunctional Sexual Beliefs: A Comparative Study of Heterosexual Men and Women, Gay Men, and Lesbian Women With and Without Sexual Problems. J Sex Med. 2019;16(9):1346–58.
[#62] McDonagh LK, Bishop C, Brockman M, Morrison TG. The associations of sexual desire, daily stress, and intimacy in gay men in long-term relationships. Int J Impot Res. 2024;36(2):131–8.
[#63] Buxton AP. Works in progress: How mixed-orientation couples maintain their marriages after the wives come out. J Bisex. 2004;4(1–2):57–82.
[#64] Wierckx K, Elaut E, Van Caenegem E, Van de Peer F, Dedecker D, Vanhoudenhove E, et al. Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration. Eur J Endocrinol. 2011;165(2):331–7.
[#65] Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher A, Toye K, et al. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med. 2014;11(8):1999–2011.
[#66] Anzani A, Panfilis C, Scandurra C, Prunas A. Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth. Am J Obstet Gynecol. 2024;230(1):103.e1–103.e10.
[#67] Khorrami A, Kumar S, Bertin E, Genoway K, Kavanagh AG. The Sexual Goals of Metoidioplasty Patients and Their Attitudes Toward Using PDE5 Inhibitors and Intracavernosal Injections as Erectile Aids. Sex Med. 2022;10(2):100505.
[#68] Djordjevic ML, Stojanovic B, Bizic M. Metoidioplasty: techniques and outcomes. Transl Androl Urol. 2019;8(3):248–53.
[#69] Bizic MR, Stojanovic B, Joksic I, Djordjevic ML. Metoidioplasty: Surgical Options and Outcomes in 813 Cases. Front Endocrinol. 2021;12:760284.
[#70] Falcone M, Garaffa G, Gillo A, Dente D, Christopher AN, Ralph DJ. Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery. BJU Int. 2018;121(1):139–44.
[#71] Heston AL, Esmonde NO, Dugi DD 3rd, Berli JU. Phalloplasty: techniques and outcomes. Transl Androl Urol. 2019;8(3):254–65.
[#73] Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. Illicit drug use in sexual settings ('chemsex') and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sex Transm Infect. 2015;91(8):564–8.
[#74] Bourne A, Reid D, Hickson F, Torres-Rueda S, Steinberg P, Weatherburn P. 'Chemsex' and harm reduction need among gay men in South London. Int J Drug Policy. 2015;26(12):1171–6.
[#75] Weatherburn P, Hickson F, Reid D, Torres-Rueda S, Bourne A. Motivations and values associated with combining sex and illicit drugs ('chemsex') among gay men in south London: findings from a qualitative study. Sex Transm Infect. 2017;93(3):203–6.
[#76] Stuart D. Chemsex: origins of the word, a history of the phenomenon and a respect to the culture. Drugs Alcohol Today. 2019;19(1):3–10.
[#77] Hammoud MA, Vaccher S, Jin F, Bourne A, Haire B, Maher L, et al. The new MTV generation: Using methamphetamine, Truvada™, and Viagra™ to enhance sex and stay safe among Australian gay and bisexual men. Int J Drug Policy. 2018;55:197–204.
[#78] Hawton K, Catalan J, Martin P, Fagg J. Long-term outcome of sex therapy. Behav Res Ther. 1986;24(6):665–75.
[#79] Dean J, Rubio-Aurioles E, McCabe M, Eardley I, Speakman M, Buvat J, et al. Integrating partners into erectile dysfunction treatment: improving the sexual experience for the couple. Int J Clin Pract. 2008;62(1):127–33.
[#81] Grubbs JB, Gola M. Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses. J Sex Med. 2019;16(1):111–25.
[#82] Hoaglund E, Grubbs JB. Pornography and sexual dysfunction: is there any relationship? Curr Sex Health Rep. 2024;16:1–13.
[#83] Grubbs JB, Kraus SW, Perry SL. Self-reported addiction to pornography in a nationally representative sample: The roles of use habits, religiousness, and moral incongruence. J Behav Addict. 2019;8(1):88–93.
[#84] Prause N, Pfaus J. Viewing sexual stimuli associated with greater sexual responsiveness, not erectile dysfunction. Sex Med. 2015;3(2):90–8.
[#85] Prause N, Binnie J. Reboot/NoFap Participants Erectile Concerns Predicted by Anxiety and Not Mediated/Moderated by Pornography Viewing. J Psychosex Health. 2022;4(3–4):153–62.
[#86] Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, et al. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci. 2016;6(3):17.
[#87] Dwulit AD, Rzymski P. The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies. J Clin Med. 2019;8(7):914.
[#93] Schnarch DM. Constructing the Sexual Crucible: An Integration of Sexual and Marital Therapy. New York: WW Norton; 1991.
[#94] Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men—A Review of the Prevalence and Risk Factors. Sex Med Rev. 2017;5(4):508–20.
[#95] Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man—worrisome picture from the everyday clinical practice. J Sex Med. 2013;10(7):1833–41.
[#96] Leiblum SR, Rosen RC. Couples therapy for erectile disorders: conceptual and clinical considerations. J Sex Marital Ther. 1991;17(2):147–59.
[#97] Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med. 2008;5(11):2562–74.
[#99] Jiang T, Osadchiy V, Mills JN, Eleswarapu SV. Is It All in My Head? Self-reported Psychogenic Erectile Dysfunction and Depression Are Common Among Young Men Seeking Advice on Social Media. Urology. 2020;142:133–40.
[#100] Babar M, Loloi J, Patel RD, Singh S, Azhar U, Maria P, et al. Is Reddit a Reliable Source for Information on Erectile Dysfunction Treatment? Sex Med. 2022;10(3):100527.
[#101] Margolin EJ, Pagano MJ, Aisen CM, Sterling J, Chung DE, Stahl PJ. Thematic analysis of the psycho-sexual symptoms in patients with Peyronie's disease present on online forums. Int J Impot Res. 2023;35(7):663–72.
[#102] Loloi J, Babar M, Maria PP, Patel RD, Watts KL. Female Sexual Dysfunction: A Reddit Analysis of the Lost Libido. J Sex Med. 2022;19(Suppl 3):S19.
[#103] Babar M, Loloi J, Patel RD, Singh S, Maria P, Watts KL. 'O' no: a Reddit analysis of orgasmic dysfunction. Int J Impot Res. 2024;36(8):816–23.
[#104] Loloi J, Babar M, Patel RD, Singh S, Watts KL. Snip, Support, and Shared Stories: Exploring Reddit Users' Experiences With Vasectomy. Sex Med. 2024;12(5):qfae064.
[#109] Iqbal M, Mohamed W, Shendy M, Shanahan A, Steggall M, Brown G. A Retrospective Review of Men Referred to a Dedicated Erectile Dysfunction Clinic in Secondary Care. Cureus. 2024;16(6):e62537.
[#110] Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N, et al. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet. 2013;382(9907):1817–29.
[#111] Mitchell KR, Jones KG, Wellings K, Johnson AM, Graham CA, Datta J, et al. Estimating the Prevalence of Sexual Function Problems: The Impact of Morbidity Criteria. J Sex Res. 2016;53(8):955–67.
Further Readings
Nagoski E. Come As You Are: The Surprising New Science That Will Transform Your Sex Life. Updated ed. New York: Simon & Schuster; 2021. — Patient-facing book on the dual-control model of sexual response and partnered desire.
[#38] Metz ME, McCarthy BW. Coping with Erectile Dysfunction: How to Regain Confidence and Enjoy Great Sex. Oakland: New Harbinger; 2004. — Patient-facing book grounding the 'Good Enough Sex' model used on this page.
Gurney K. Mind the Gap: The Truth About Desire and How to Future-Proof Your Sex Life. London: Headline Home; 2020. — Patient-facing book on the desire gap and partnered intimacy.
Fern J. Polysecure: Attachment, Trauma and Consensual Nonmonogamy. Portland: Thorntree Press; 2020. — Attachment-informed reading for non-monogamous and mixed-orientation relationship structures.
Hardy J, Easton D. The Ethical Slut: A Practical Guide to Polyamory, Open Relationships, and Other Freedoms in Sex and Love. 3rd ed. Berkeley: Ten Speed Press; 2017. — Reading for non-monogamous and open-relationship contexts referenced in the page's H2 #6.
[#98] College of Sexual and Relationship Therapists. The COSRT Register — public register of UK psychosexual therapists.
Source:COSRT.ORG.UK
[#108] British Association of Urological Surgeons. Erectile Dysfunction (Impotence) — Patient Information Leaflet. Leaflet No A24/079. London: BAUS; 2024.
