When we talk about the disruption that erectile dysfunction (ED) treatment causes, we often look at it very one-dimensionally. A man usually believes that 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 was historically referred to as “impotence.” However, while there are treatments available for erectile dysfunction, the accurate measure of success goes beyond merely achieving an erection. Ultimately, satisfaction in 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 are ultimately not looking for treatment beyond the very 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 pursue further treatment, such as a penile implant, if their partner isn’t engaged in their intimate life? This common occurrence has made it very clear to me: Erectile dysfunction treatment is not just a man’s problem—it is truly a couple’s problem, and its solution should be approached as a team.
What Do I Mean by That?
Ultimately, for people in a committed, long-term relationship, there is a natural decline in sexual activity. As we age, sex tends to become less central in our relationships, influenced by psychological and physiological factors. Male hormones, particularly testosterone, begin to decline after age 40, impacting 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 closeness is such a critical part of a relationship, do we resign ourselves to losing this aspect of intimacy, or should we explore ways to maintain it? Fortunately, there are low-risk, non-invasive therapies available for both men and women that can help restore sexual function and satisfaction. And that is precisely what we are going to talk about.
While I don’t treat female sexual wellness myself, I often speak to 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. Oftentimes, 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 to explore available treatments that could improve their spouse’s sexual wellness.
For younger women—typically 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 a significant role. For women over 40, vaginal estrogen therapy can help improve vaginal lubrication, making sex more comfortable and pleasurable. Importantly, vaginal estrogen remains localized and does not enter the bloodstream, making it a safe option for many women, even those with concerns about systemic hormone therapy.
Male Sexual Health: Addressing the Other Half of the Equation
Once we address female sexual health considerations, we can then shift the focus to the male side, which I most definitely treat. At this stage, I work with my patients to determine how they can best meet their partner’s sexual expectations while also addressing 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 satisfying sex life. However, when these first-line treatments are no longer effective, it’s 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) is playing a role in reduced libido or sexual function. As we’ve discussed, not all patients with low testosterone levels suffer from clinical hypogonadism. Some men may have levels that appear low on a blood test but do not experience symptoms, while others may have normal levels but still struggle with libido and energy.
Fortunately, there are multiple ways to address testosterone deficiency. These range from natural 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 primary culprit of sexual dissatisfaction later in life, it’s essential to acknowledge that female partners may also be experiencing age-related changes that impact their desire and comfort. Unfortunately, women’s sexual wellness does not receive nearly as much research and attention as men’s sexual health, despite its importance.
