When we talk about the disruption caused by erectile dysfunction (ED) treatment, we often see it in a very one-dimensional way. A man usually believes he is “less than” because he cannot achieve or maintain an erection for intercourse or other sexual activity. It can be embarrassing, leaving him feeling powerless. This sense of inadequacy is one of the reasons this condition is historically referred to as “impotence.” However, while there are treatments available for erectile dysfunction, the exact measure of success goes beyond simply achieving an erection. Ultimately, satisfaction with ED treatment revolves around a man’s willingness and desire to be with his partner — and vice versa.
I often see patients who have erectile dysfunction but ultimately do not seek treatment beyond first-line options such as pills that can be taken on demand. It’s an interesting situation because when I ask them what they want to achieve, they often complain that their spouse is not interested in sexual activity. So they wonder why they should pursue further treatment, such as a penile implant, if their partner is not involved in their intimate life? This common occurrence has made it abundantly clear to me: Treating erectile dysfunction is not just a man’s problem — it’s truly a couple’s problem, and its solution must be approached as a team.
What do I mean by that?
Eventually, for people in a committed, long-term relationship, there is a natural decline in sexual activity. As we grow older, sex tends to become less central to our relationships, influenced by psychological and physiological factors. Male hormones, especially testosterone, begin to decline after the age of 40, affecting libido. Women experience a more dramatic decline in estrogen during menopause, which can occur in their mid-40s, 50s, or even early 60s.
Since sexual intimacy is such a crucial part of a relationship, are we resigned to losing this aspect of intimacy, or should we explore ways to preserve it? Fortunately, there are low-risk, non-invasive treatments available for both men and women that can help restore sexual function and satisfaction. And that’s exactly what we’re going to talk about.
Although I do not treat women’s sexual wellness myself, I often talk with my male patients about whether their partners are interested in sexual activity. This helps me assess the patient’s suitability for more advanced treatment options, such as a penile implant. Often, they tell me that their wife or partner has little desire for sex, or that sex is uncomfortable or even painful. In these cases, I encourage my patients to have open conversations with their partners and explore available treatments that could improve their spouse’s sexual well-being.
For younger women—usually those within 10 years of menopause—hormone replacement therapy (HRT) may be a viable option. However, this decision should always be discussed with a healthcare provider, as individual health factors play an important role. For women over 40, vaginal estrogen therapy can help improve vaginal lubrication, making sex more comfortable and enjoyable. Importantly, vaginal estrogens remain localized and do not enter the bloodstream, making them a safe option for many women, even those who are concerned about systemic hormone therapy.
Men’s Sexual Health: Addressing the Other Half of the Equation
Once we deal with women’s sexual health issues, we can then focus on the male side, which I certainly do. At this stage, I work with my patients to determine how they can best meet their partner’s sexual expectations while also meeting their own needs.
For men with mild to moderate ED, oral medications (such as PDE5 inhibitors) or injectable treatments may be enough to maintain a satisfactory sex life. However, when these first-line treatments are no longer effective, it is time to discuss more permanent solutions, such as a penile implant. No matter how severe the erectile dysfunction is, a penile implant offers a guaranteed way to achieve an erection. Additionally, many patients are relieved to learn that their libido (sexual desire) and sensation remain unaffected by the implant. Some patients report that their desire increases – likely due to the psychological benefits of knowing they can achieve an erection consistently.
The role of testosterone in sexual health
At this point, it is also important to assess whether low testosterone (Low T) plays a role in decreased libido or sexual function. As we have discussed, not all patients with low testosterone levels suffer from clinical hypogonadism. Some men may have levels that appear low in a blood test but show no symptoms, while others may have normal levels but still struggle with libido and energy.
Fortunately, there are many ways to treat testosterone deficiency. These range from physical lifestyle changes – such as weight management, exercise and improved sleep – to medical interventions, including testosterone replacement therapy (TRT). The right approach depends on the individual’s needs and medical history, so a thorough evaluation is always recommended.
The bottom line
While we tend to focus on male erectile dysfunction as the main culprit of sexual dissatisfaction later in life, it’s important to recognize that female partners may also experience age-related changes that affect their desire and comfort. Unfortunately, women’s sexual wellness does not receive as much research and attention as men’s sexual health, despite its importance.
