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Sexual Dysfunction in Women Partners of Men With Erectile Dysfunction

Article  in  International Journal of Impotence Research · April 2006

DOI: 10.1038/sj.ijir.3901367 · Source: PubMed

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 International Journal of Impotence Research (2006) 18, 44–46
& 2006 Nature Publishing Group All rights reserved 0955-9930/06 $30.00
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ORIGINAL ARTICLE
Sexual dysfunction in women partners of men with erectile
dysfunction
A Greenstein1, L Abramov2, H Matzkin1 and J Chen1
1
Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv,
Israel; 2Sex Therapy Clinic, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel

We evaluated 113 female partners of men with erectile dysfunction (ED) attending a sexual
dysfunction clinic in order to define sexual dysfunction among these women. In all, 51 (45%)
women denied having any sexual dysfunction. The other 62 (55%) responded to questions
classifying their complaint(s) according to the international classification of female sexual
dysfunction (FSD) in the following topics (40/62, 65%, reported having more than one problem):
decreased sexual desire (n ¼ 35, 56%), sexual aversion (none), arousal (n ¼ 23, 37%) and orgasmic
disorders (n ¼ 39, 63%), dyspareunia (n ¼ 19, 31%), vaginismus (n ¼ 3, 5%), and noncoital sexual
pain (none). Many female partners of men with ED report having some form of sexual disorder,
mostly orgasmic problems and decreased sexual desire. Therefore, for optimal outcome of ED
treatment, evaluation and treatment of male and FSD should be addressed as one unit within the
context of the couple, and be incorporated into one clinic of sexual medicine.
International Journal of Impotence Research (2006) 18, 44–46. doi:10.1038/sj.ijir.3901367;
published online 28 July 2005

Keywords: female sexual dysfunction; couples; erectile dysfunction; BISF-W

Introduction management of sexual problems calls for coordina-

For most individuals, a satisfying sex life is an
important ingredient of a healthy lifestyle. Sexual
problems are widespread and related to both health
status and psychosocial factors and may affect the
relationship between the couple.1–4 Erectile dys-
function (ED) hampers the quality of life of both the
male and his female partner. Effective treatments for
ED are available, but re-establishing erectile func-
tion does not necessarily re-establish a satisfying
sexual relationship of the couple due to an existing
female sexual dysfunction (FSD),3 thus the increas-
ing awareness and interest in FSD. Several surveys
have estimated that 18–76% of adult females
complain of sexual dysfunction and that many have
never been evaluated by their physicians.2–4 There-
fore, for optimal outcome of ED treatment, the
Correspondence: Dr A Greenstein, Department of Urology,
Tel-Aviv Sourasky Medical Center, 6 Weizman Street,
Tel-Aviv 64239, Israel.
E-mail: surge04@post.tau.ac.il
Received 5 May 2005; revised 3 June 2005; accepted 8 June
2005; published online 28 July 2005
tion of the evaluation and treatment of male and
female sexual problems as one unit within the
context of the couple.1,3,5–7
We designed this prospective study to character-
ize sexual dysfunction in women who accompanied
their partners to our male sexual dysfunction clinic.
Materials and methods
During the study period, 295 men were evaluated, of
whom 205 (69%) were accompanied by their female
partners to our Male Sexual Dysfunction Clinic. Of
these 205 consecutive couples, 113 women (55.1%,
mean age 59.372.06 years, range 27–83) agreed to
participate in this prospective study. Their 113 male
partners (mean age of 64.673.20 years, range 29–85)
were being evaluated at the clinic due to ED. Each
female partner was given the choice of filling out the
questionnaire either in the presence of her partner or
in privacy. They were also given the option of
answering the questions themselves or with the help
of one of the investigators.
The Brief Index of Sexual Functioning for Women
(BISF-W)8 was used to determine the female
 Sexual dysfunction in female partners of men with ED
A Greenstein et al
45
participants’ complaints according to the classifica- 50

tion of FSD:9 The questions addressed the following 40

topics:

No of patients
30
1. Female hypoactive sexual desire disorder (FHSD) 56%
63%
20
defined as ‘The persistent or recurrent deficiency
37%
(or absence) of sexual fantasies, and/or desire for, 10 31%
or receptivity to, sexual activity, which causes 5%
0
personal distress.’

IA

S
L

U
SM
E

N
SA

M
R
2. Sexual aversion disorder (SAD) defined as ‘The

U
A
SI

IS
E
U

R
E

IN
O

A
D

G
O
persistent or recurrent phobic aversion to and

SP
A

A
Y

avoidance of sexual contact with a sexual partner
which causes personal distress.’
3. Female sexual arousal disorder (FSAD) defined as
‘The persistent or recurrent inability to attain or
maintain sufficient sexual excitement, causing
personal distress. It may be expressed as a lack of
subjective excitement or a lack of genital lubrica-
tion/swelling or other somatic response.’
4. Orgasmic disorder defined as ‘The persistent
or recurrent difficulty, delay in, or absence of
attaining orgasm following sufficient sexual
stimulation and arousal, which causes personal
distress.’
5. Dyspareunia defined as ‘The persistent or recur-
rent genital pain associated with sexual inter-
course which causes personal distress.’
6. Vaginismus defined as ‘The persistent or recur-
rent involuntary spasm of the musculature of
the outer third of the vagina that interferes
with vaginal penetration, which causes personal
distress.’
7. Noncoital sexual pain disorder defined as ‘The
persistent or recurrent genital pain induced by
noncoital sexual stimulation which causes perso-
nal distress.’
The BISF-W questionnaire does not contain any
questions that refer to the possibility of noncoital
sexual pain disorder; therefore, all participants were
asked directly if noncoital sexual stimulation (hug-
ging, kissing, fantasizing) caused them genital pain.
Based upon their replies, the women were classified
to at least one of the FSD categories. Any positive
response was considered as an FSD.
Results
Of the 113 women in the study, 51 (45%) denied
having any sexual disorders. The remaining 62
(55%) reported having at least one type of sexual
dysfunction and 40 them (64%) reported having
more than one. The mean duration of their sexual
problem(s) was 3.5 years (range 8 months to 10
years). In all, 39 (63%) reported having orgasmic
problems, 35 (56%) decreased sexual desire, 23
(37%) arousal disorder, 19 (31%) dyspareunia, and
3 (5%) vaginismus. None of the women complained
of SAD or noncoital sexual pain disorder. The
V
D
Figure 1 Distribution of sexual dysfunction by complaint.
distribution of the type of sexual dysfunction in
the patient cohort is shown in Figure 1.
The visit to the male sexual dysfunction clinic
had been initiated by 103 (91%) of these women,
and 72 (64%) women expected to be questioned
about their own personal sexual dysfunction.
The etiology of the ED in most of the patients
(n ¼ 98, 87%) was mixed psychogenic and organic.
The men underwent a medical and sexual history,
physical examination, psychological profile and
endocrine evaluation for the etiology of ED. Invasive
evaluations, such as Doppler ultrasound examina-
tion of penile vasculature with artificial erection
induced by intrapenile injection of vasoactive
medications, cavernosography, and cavernosome-
tery, were reserved for selected patients. There was
no correlation between an existing FSD and the
etiology or timing of the ED.
Discussion
Male sexual function has long been a part of
urological practice and research. Optimal manage-
ment of ED requires the partner’s collaboration.
Partners’ resentment of ‘artificial’ means of erection
may cause discontinuation of effective treatments for
ED.7 In spite of the impact of ED on the sexual life
of female partners, much relevant information on
FSD is still lacking or is insufficient. A broad-based
international effort improved the diagnosis of FSD by
means of standardization of categories of distur-
bances and/or type of complaint(s).5,6,9 Although
there are some concerns regarding the reliability of
the suggested classifications,10,11 the Report of The
International Consensus Development Conference on
Female Sexual Dysfunction recommended the BISF-
W in the assessment of FSD,9 and we consider that
the questionnaires had been effectively applied in the
current study in terms of nature and quantity of data
yield. While using this questionnaire for assessment
and classification of the women’s sexual dysfunction,
however, we did have some difficulty in convincing
all of the eligible women to take the time to use this
time-consuming tool.

International Journal of Impotence Research

 Sexual dysfunction in female partners of men with ED
A Greenstein et al
46
It is noteworthy that the majority (91%) of our
study women initiated their partner’s visit to the
clinic and that 64% of them had anticipated being
questioned about their personal sexual problems.
Indeed, the relatively high rate of FSDs reported in
this study may have accounted for the initiation of
the visit of their partners to our Male Sexual
Dysfunction Clinic.
The high proportion of female partners with FSD
in our study (55%) demonstrated the importance
of taking a sexual dysfunction history from both
partners. FSD, which appeared to have a strong
negative effect on the success of the male partner’s
treatment, is a factor that needs to be recognized
by urologists who treat male sexual dysfunction.12
In our current experience, the ‘couple’ approach
helped to detect heretofore unidentified FSD in
apparently healthy women.
As we evaluated females accompanying their
partners, our results may not reflect the character-
istics of females specifically seeking evaluation for
their FSD. In all, 55% of the women accompanying
their partners comprised our study population: if all
the women accompanying their partners had agreed
to participate, this could have affected our results.
Moreover, since we did not expect such a high
percentage of female partners with sexual problems
of their own, we did not consider collecting data
that could indicate whether there was any correla-
tion between the timing of the FSD appearance with
the timing of their partners’ ED. The design of this
study was to look upon these women solely as
partners of the men being treated in our Male Sexual
Dysfunction Clinic. We limited our focus to whether
or not they felt that they, themselves, had any
problems in functioning sexually and the nature of
their problems. We did not expand our investigation
to include the many other parameters relevant to
FSD (age, hormonal status, religious status, educa-
tion, previous sexual experience, parents’ attitude
toward sexual activity at various stage of life, etc.).
Furthermore, due to some women’s refusal to
address the questions and to participate in our
study, information about their FSD and correlation
to the various parameters affecting sexual function
is unavailable.
Relational factors in addition to organic, psycho-
logical, can coexist in men with ED, and FSD may
play a role on inter-relationship of the couple.
Therefore, using structured interviews such as the
SIEDY that provides a quantitation of disturbances
in relationship with a partner could be relevant in
International Journal of Impotence Research
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everyday clinical practice as a guide for subsequent
psychosexual counseling for the couple.13
In conclusion, we found that a high proportion of
female partners of men with ED (55%) report having
one or more FSD. Most of the visits to the male
sexual dysfunction clinic (91%) were initiated by
the female partners, and most of the studied females
(64%) had expected to be questioned about their
personal FSD. Therefore, for optimal outcome of ED
treatment, evaluation and treatment of male and
FSD should be addressed as one unit within the
context of the couple, and be incorporated into one
clinic of sexual medicine.
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