Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.


Dear Dr. Pat,

I am 51 years old, married for 25 years and the mother of two children who are now living on their own. I am a teacher and my husband works in the family insurance business. We are middle-class people who live within our means, go to church and have a nice life.

I had a few sexual partners before I married my husband, had orgasms easily when I became comfortable with a new partner, and never had any bad sexual experiences. I am now two years past menopause. My husband is 56, about 30 pounds overweight, and takes medicine for high cholesterol and high blood pressure. He does not exercise much and doesn’t have many interests other than sports on television and spending time with his extended family, all of whom are nice people.

We had a very good sex life even after the children were born. We always found time for each other. About five years ago he began to have some problems with performing and at the same time I felt that he had just lost his interest in sex. I felt sure that it was me, so I lost weight and increased my exercise, bought some nice lingerie and tried for awhile to initiate sex. I tried to talk to him about the “issue,” but he did not want to even talk to his doctor because we’re in a small town and he clearly did not want his high school buddy knowing about this. He just said that we were both getting old and we should count our blessings.

I miss our sex life. Are the drugs for impotence dangerous? How can I get him to talk about this? He acts like he has no libido at all.

Connie


Dear Connie,

This is a far more common problem than you know, in spite of the constant advertisements about erectile dysfunction drugs. Women who have had a healthy libido, who are physically and emotionally healthy, and whose relationships have been good both in and out of bed, do continue to want to have partnered sexual intimacy. It is the women who never had much of a libido or whose life partners were never that good anyway, or women who are suffering from emotional, physical, or life stresses who are more likely to blame menopause for their loss of libido.

The problem you have is that your husband needs an evaluation for both the loss of libido and the performance issues. Too often, men and women assume that loss of libido is due to shame from erectile dysfunction. They blame the erectile dysfunction on side effects of medication or common medical problems like high blood pressure, elevated cholesterol, and obesity. Lots of men who have enjoyed their sex lives and who have been exposed to countless hours of Viagra, Cialis, and Levitra ads from television sporting events are at least asking their doctor about a trial of a medicine to improve erectile function. But depression and low testosterone can impede the interest that a man would otherwise have in an evaluation for treatment.

I suggest that you work on finding a counselor whom you could ask your husband to see with you in a city near your town. A counselor for both of you reinforces the concept that erectile dysfunction is not a man’s problem. It is often a relationship opportunity. The counselor could evaluate your husband for depression and could refer him for hormone testing, since low testosterone commonly part of the cause of loss of libido in men. Remind your husband of your happy memories of years of love making and point out that there are many avenues of treatment available.

I have asked Dr. J. Francois Eid, a urologist and director of Advanced Urological Care, who specializes in the complicated evaluation and treatment of erectile dysfunction, to give you more information about these issues. His response is below

It is terrific that you sent in this question. Women’s concerns and reactions to their partners’ loss of interest in sex, accompanied by erectile dysfunction, often lead them to assume that they are the problem. Good for you that you want more in your life.

Best,

Dr. Pat

Dear Connie,

Thank you so much for taking the initiative to seek a solution for your sexual relationship. By doing so you are already contributing to the wellbeing of your relationship as well as inspiring others to do the same. Taking the first step is so hard for most men. Many men, when confronted with a physical problem such as ED and lack of sexual desire, become resigned and avoid any physical contact for fear that it will lead to sexual intimacy and failure in the bedroom. It is easier to give up and pretend that sex is no longer important. Furthermore, medications that treat high blood pressure often cause or exacerbate erectile dysfunction. 

So how do we get him to take the first step?

Your husband has an increase in abdominal girth, obesity, elevation in his cholesterol levels, hypertension, and erectile dysfunction. These are all part of a condition we now call the “Metabolic Syndrome.” This condition is also associated with low testosterone levels, which further exacerbates the patient’s ability to metabolize fat. More recently, an association between coronary artery disease and erectile dysfunction has been described in several peer-reviewed medical publications. Perhaps you could accompany your husband on his next visit to his medical doctor. You may at some point mention, during the visit, that you read something on the internet about the metabolic syndrome and low testosterone levels.

Diagnosing and treating low testosterone level may help reduce weight, increase physical activity, improve sexual desire, and help “unreliable” erections. This may provide an opportunity to segue into the topic of ED without mentioning the word impotence. Words such as impotence and erectile dysfunction are very embarrassing for men, especially if a man socializes with his doctor, as your husband does in your small town. In addition, you may mention to the doctor that you have read that some pills for the treatment of high blood pressure may cause erections to become unreliable.

“Unreliable” erections, however, are common to most men at some point or another, regardless of age or health status. Seeking advice and evaluation in order to improve one’s performance is a sign of virility and indicates to the doctor that the patient is responsible for and interested in the continued success of the physical part of his marriage. Cialis 5mg taken on a daily basis has fewer side effects than the other medications (Viagra, Levitra and Cialis on demand) and allows a man to engage in sexual activity in a spontaneous, natural way.

Planning for intercourse often kills the mood and prior failures in the bedroom increase performance anxiety. Daily Cialis will also restore morning erections, which for some men is a reassuring sign that sexual performance will be more successful. This is very encouraging for men who have had past difficulties with performance. At a later date and according to frequency of sexual activity, the medication regimen may be adjusted to an on-demand medication.

Hope that this will provide you with some information which will enable you to get your husband to take the first step.

Regards and good luck,

J. Francois Eid, M.D.

Join the conversation

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  • Doyle Vandernoot November 21, 2015 at 5:24 pm

    Very insightful article. Answers a lot of my questions about ED. Thank you for the info

    Reply
  • Freja July 4, 2014 at 5:08 pm

    I treat ED professionally and after working with men solo for years, maintain that it is a couple’s issue. The previous discussions were interesting, but what I’ve found with clients is that if it’s not medically caused prostate removal, medication, and most of the time it’s not, the “cause” is in the relationship. There is no blame here, but both partners need to
    1. Understand that your sexuality is not separate from your emotions
    2. You’re both responsible for communication and the sexual environment
    3. It’s normal to sometimes be soft. If a man is soft because he’s tired, stressed, or otherwise run down … it’s not a big deal. His penis is not an independently operating tool with an on button, though it may have been at 18. Women aren’t in the mood sometimes either, but there is no reason to eschew sensual intimacy because he’s not ready to rock and pump and thrust on demand. Cuddling, caressing, sensual kissing and genital massage is not only enjoyable no matter what a person’s state of erection is, the no expectation environment often leads to an erection and will do so more often over time.

    It is damaging to think that a woman has no role in her partner’s sexual response. Just as it is damaging to think a man plays no role in her arousal. Sure he does, both emotionally and physically.

    Reply
  • Andrea August 6, 2012 at 10:35 pm

    Highly interesting details you’ve remarked, appreciate it meant for putting up.

    Reply
  • Patricia Yarberry Allen, M.D. February 23, 2012 at 1:06 pm

    Dear Mary,

    We have certainly entered the new world of insurance mandated drug control. Women pay over 100.00 a month for estrogen that is used in genital area. And, you are right about the cost of the ED drugs. We will have to give a new meaning to the term, Sexcation! We can choose to save our money from a traditional vacation and buy the drugs we need in order to have sex at home.

    Best,

    Dr. Pat

    Reply
  • Granny November 1, 2011 at 8:18 pm

    Please tell me where the man’s understanding and wanting to help a woman who has a low sex drive, doesn’t get aroused, etc; usually way earlier in life. And there’s NOT much in the way of anything to help her. Couples move apart when he has ed because … ????… Maybe you should really advise the women to go look for another man to satisfy her just as though men do themselves if it were the woman with any kind of issues. Believe me, long term married couples will find plenty of other things besides sexual intercourse that is plenty satisfying IF and ONLY if they had a good intimate relationship beforehand. If it’s only sexual intimacy they engage in.. it’s a doomed marriage.

    If a man cared about the issues he may have, he’d do the research himself. It’s up to HIM to find solutions and then bring them to his wife/partner. It’s up to HIM to open up the communication regarding HIS problem. Not the other way around. Men are NOT children; therefore they should act on their own. If a man can’t, then it’s not really worth being with a man, is it? Men have no problem with handling other things and finding solutions for other problems. No difference here. I don’t buy into all the hogwash about men and their invincible selves that’s said to be. My dad and other men have no trouble calling a doctor and researching.

    And yes, I’d be there for my husband,
    but it has to start with HIM.

    ‘So what started as “his problem” can become “their problem.”’
    What’s started as ‘her problem’ is ALWAYS her problem and hers alone it’s said.

    Reply
  • Granny October 31, 2011 at 9:47 am

    You also forgot to mention that a man will start to ‘lose’ interest if he’s cheating and/or looking at porn.

    Reply
  • Granny October 31, 2011 at 9:41 am

    Patricia,

    No matter what a ‘solution’ may be, if the man doesn’t respond, it won’t matter. ALso, it’s up to him to try to find a solution, whether it’s a counselor, med doctor, or whomever. Men tend not to listen anyways, so why should she overstep what’s not her physical problem? Do we as women expect men to find solutions to what ails women?

    Do women expect men to find the solution for HER??? Don’t believe so. But also, many times, it is a man’s fault for her sexual response due to how the psychological aspect is normally always there. Just the drive alone, not anything else.

    If my husband suffered from ED, it’s his problem, not mine. Affect our relationship?? Nope, because there’s alot more to a relationship than the sexual one. Many years of marriage proves this.

    Ignoring what the problem is is a solution if it’s not problem enough to make HIM want to figure out what’s going on.

    So.. sure, all the pills in the world, etc won’t do a thing if HE doesn’t apply the ‘solution’, does it??

    Sometimes it’s best to just keep a mouth shut. This is one such time.

    Oh, and women will and do blame themselves fo the problem. How many times do you see 50-60 year old men write that all they need is a slimmer, pretty young gal again?? So the woman who’s maybe 40-50, has had children, raking on 30 extra pounds through the years, some wrinkles, is BOUND to blame herself.

    It’s HIM who seek what his problem is; whether it’s physical or psychological. It’s HIM who has to reassure his wife it’s not her fault.

    One can lead a horse to water, but can’t make the horse drink it. That’s the way men tend to be. Stubborn. A man HAS to be the one to try things. A woman can find reasons and solutions available, but unless he is willing to try, it’s useless.

    You mention testosterone. This is only ONE hormone that could be the problem. EVERY hormone needs testing as to their levels.. and the thyroid. One hormone, prolactin can cause it too. As a DOCTOR, you should know that.

    Why do infants and young boys get erections when they’re testosterone levels are so very low compared to the average man’s levels? Why are boys, prepuberty, so interested in girls?? Why do some engage in sexual activity? Testosterone is not a main factor in this things. The BRAIN is the largest sex organ in males, too. Being HEALTHY men is a requisite of functionality. Of which they care less about their health until they have such problems.

    Reply