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couples therapy, sex therapy for couples

by Janet Casperson, BS, MSN, ANP-C

Couples therapy is valuable since sexual dysfunction is not just an individual's problem, it is a couple's problem.

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Couples therapy can open up communication 

The effects of ED and/or FSD can be dramatic and devastating to the relationship. Challenges to the treatment of sexual dysfunction which affect the relationship for the couple include unfamiliarity of the disorder, under-diagnosis of the disorder, the cost of therapy, embarrassment and adherence to the recommended therapy. The impact of the disorder can manifest itself in complex psychological and interpersonal issues, diminished physical and emotional intimacy and decreased satisfaction with relationships and sexual life. Both partners may have distressing emotions including embarrassment, shame, self-doubt, shyness, feelings of inferiority, anxiety, depression, fear, apprehension, loneliness, disconnection with the partner and others, anger, resentment and frustration.

Many men, women and couples may be unaware of the different types of sexual dysfunction. A popular belief is that sexual dysfunction is a part of the normal aging process and an inevitable way of life. Daily, in the clinic, women and men report to us that their relationship with their partner is good, and they do not need sex or sexual intimacy in their life. Yet, here they are in a Sexual Dysfunction Clinic wanting to find out why the disorder is present, how extensive it is and whether it can be treated. At least a few of the couples are seeking treatment.

When a man has ED, he may feel that his masculinity is threatened, he is no longer in control and that he is a failure. He may lack confidence and feel shame, anxiety, insecurity and depression. A man may report "I am a failure at pleasing my partner" and believe that that his partner is upset with him because of the sexual disorder. These feelings and distressing emotions may diminish his quality of life. It is important for the partner remember that sex is important to men throughout their entire life and to deemphasize or ignore the problem can lead to feelings of alienation, frustration and isolation. It is through open communication that the couple will be able to address and resolve issues associated with ED. Sex therapy or couples therapy can help a couple communicate about their sexual problems.

Who seeks sex therapy?

Recent studies have shown that up to 70% of men with ED do not seek treatment. Men do not seek treatment for ED for various reasons. The reasons include stress, embarrassment, the partner's ability or willingness to participate in the treatment process, belief that loss of erectile function is permanent or that little can be done to treat the ED, the cost of treatment or the belief that treatment can be harmful. If the man or the couple is not comfortable with the health care provider, their discomfort and embarrassment may be another reason for not seeking treatment of sexual disorders. It is reported that approximately half of men who seek treatment for ED stop the therapy. The good news is that men in the US and United Kingdom with ED are usually older, married men who are more likely to seek treatment for ED. However, if a man does not seek treatment or does not adhere to the therapy and the lifestyle modifications for the disorder, the relationship will continue to be impacted.

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The financial burden of treatment plays a role in the treatment or adherence to treatment for ED. The cost of the medication can be as much as $12 per pill with testosterone replacement costing as much as $300 per month. The insurance reimbursement may be minimal or nonexistent. Some insurance companies view ED as a "quality of life" issue and do not cover treatment on any level, no matter the cause. The cost of a visit to a health care professional, the diagnostic studies and the prescribed treatment all represent reimbursement issues that impact the relationship.

Methods of minimizing the effect are far more successful when both partners are actively involved in the treatment process. This level of involvement will establish a more accurate sexual history, reduce stress and anxiety, set realistic expectations of each other and enhance the couple's communication.

The role of couples therapy

Communicating or talking about the ED problem and other sexual problems with your partner is essential. Ignoring the problem will not make the situation better. Some tips for communicating:

DO:
DON'T:
  • communicate with understanding and compassion
  • be critical or place blame on one partner or the other
  • give reassurance and express love for each other often
  • focus on the sexual dysfunction disorder in daily interactions with your partner
  • be supportive
  • criticize, judge, get defensive, take or give blame
  • continue loving your partner
  • stop being affectionate, accept excuses or feel as if the love is gone from the relationship
  • be active in the treatment process
  • ignore or avoid the problem


Carefully selecting the best environment for talking is important. Select a time when you will be uninterrupted and when here will be enough time to fully discuss the problem. Remain calm and relaxed during the discussion. Let the time together facilitate bonding and getting closer to one another in the relationship.

The success of communication between couples is influenced by many factors. These factors include basic assumptions about the disorder and treatments, current beliefs or standards of the couple, expectations of treatment outcomes and feelings of confidence or resentment. When barriers to communication are apparent, we often recommend therapy with a multi-disciplinary team that might include many disciplines: urology, primary care, pharmacology, endocrinology, cardiology, neurology, psychiatry, spiritual or religious counseling, marital therapy and sex therapy. This team brings expertise and experience, which enables the couple to better identify the specific issues and develop methods of coping with the disorder. This team approach is beneficial in teaching the couple to stop avoiding the problem and realize that it is a significant issue that can be easily improved if approached in a delicate, accepting, empathetic manner of cooperation. It is through this approach that many of the couples that we treat have found their way back to enjoying a life filled with intimacy and sexual fulfillment.

References: See Bibliography

August 2006
Posted August 2008
Updated March 2012

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