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It’s common for anyone to have occasions when it’s difficult to get sexually aroused, or maintain arousal, while getting intimate but it can come with feelings of shame, disappointment and guilt for both parties. If your partner experiences erectile dysfunction, providing support, understanding and open communication will be helpful for you both. If these problems are persistent, it could be a sign of an issue that needs investigating.

Erectile dysfunction is unlikely to be permanent. It can be successfully treated in many cases, using tablets, injections or surgery. The more you know about the condition and how best to work together with your partner, the better the outcome will be.

What is erectile dysfunction and how common is it?

Erectile dysfunction is the difficulty getting or maintain an erection and dysfunction it’s a common sexual problem. Between 1% to 10% of men under 40 are regularly unable to get an erection or to maintain an erection long enough for satisfactory sexual activity. The prevalence of erectile dysfunction increases with age, affecting 2 to 15% of men in their 40s, around 25% in their 50s, up to 40% in their 60s and almost all men aged 70 and older. While it’s more common as you get older, sexual health is always important and there’s no age when you’re ‘too old’ to get help with erection problems.

 

Learn more about erectile dysfunction on our health topic page.

 

What causes erectile dysfunction?

Erectile dysfunction may be caused by psychological problems such as stress and anxiety, or physical problems including nerve function and blood flow. Psychological factors are more common causes in young men, whereas physical causes are more common in older men.

Erectile dysfunction rarely occurs without some other underlying problem. Even if erectile dysfunction is not a problem for your sex life, it’s still important for your partner to see a doctor. If mental health is contributing to his erectile dysfunction, it may be reducing your quality of life in other ways and physical causes may be signs of underlying disease.

Men with erectile dysfunction are more likely to have cardiovascular disease than men with normal erectile function. Erectile dysfunction occurs 3 to 5 years before other effects of coronary heart disease, which means that after erectile dysfunction starts there is time for men to take action to prevent heart attacks and other impacts of cardiovascular disease.

What someone with erectile dysfunction could be feeling

Depression and anxiety are common impacts of erectile dysfunction, and both can contribute to further problems with sexual function, including reduced libido or arousal. They may contribute to denial of the problem, not seeking help, or not using treatment. Erectile dysfunction can also make men feel angry, isolated, guilty, and affect their self-esteem.

What you might be feeling

Erectile dysfunction isn’t just an individual problem – it also affects sexual partners. Female sexual partners of males with erectile dysfunction report problems with their own sexual function and satisfaction.

Some partners of men with erectile dysfunction feel confused or anxious and may question their relationship or their partner’s feelings for them. The psychological impact can lead to sexual dysfunction of their own, with effects on their quality of life. Although it can feel personal, no one is to blame for erectile dysfunction. Good communication between partners about erectile dysfunction and its effects is helpful. It’s important to seek help if your sex life or mental health is impacted too.

What you can do when your partner has erectile dysfunction

It can be difficult to discuss erectile dysfunction with your partner, but most men with the condition think their partner’s support is important. Men who know their erectile dysfunction is having an effect on their partner and have their partner’s support are more likely to see their doctor for help. Gently encourage your loved one to open up, assure them it’s an issue you can work through together and suggest professional support. An appointment with their GP is essential and specialists like counsellors or psychosexual therapists can also help.

Treatment of erectile dysfunction is more likely to be successful, and the results more satisfying for both partners, if both of you are involved in seeking help and managing treatment. Female partners of men who use tablets to treat their erectile dysfunction report better sexual function and satisfaction, and better quality of life, than those whose partners choose not to receive treatment. It’s important to understand that treatment is unlikely to be a quick process with some trial and error involved in finding a solution that works for you both. Counselling can help with keeping communication open and effective, as well as helping you explore other forms of intimacy.

A couple might try to go it alone, managing erectile dysfunction themselves, but this can place strain on the relationship. Regardless of the cause of erectile dysfunction, getting the help of someone who is experienced and has expertise offers the best chance of a good outcome.

Although some aspects of erectile dysfunction may be different between men who have sex with females and those who have sex with men (e.g. recreational use of erectile dysfunction medicines and other drugs), considerations about effects on partners, and the benefits of partner’s support and engagement are the same.

 

Learn more about erectile dysfunction on our health topic page.

Male and female genitals come in all shapes and sizes.

Your partner’s opinion about how their genitals look can affect how confident they are during sex, and their sexual satisfaction and function, and negative comments about men’s general physical appearance from their partners can have a negative effect on their body image3. Understanding men’s genital appearance, and knowing what’s normal and what’s not, may help foster a healthy and satisfying sexual relationship.

Penis size

A normal penis size ranges from 5 to 15.5 cm long and 6.5 to 13 cm in circumference (the distance around the outside, or girth) when flaccid, to 7.5 to 19 cm long and 9 to 16 cm in circumference when erect. Only 1 in 10 men think they have a small penis but almost half of men who think their penis is ‘average’ would like it to be bigger. Men’s partners are, in fact, more likely to be very satisfied with the size of their partners’ penis than the men themselves.

Penis curvature

It’s normal for a penis to have a slight curve when erect. Some males have more severe curves or bends due to Peyronie’s disease — a condition that affects the connective tissue that surrounds the erectile tissue in the penis. The cause may be as a result of repeated damage or injury to the penis during sexual activity.

Peyronie’s disease can be painful, but the greater problem is that intercourse can be difficult or even impossible. This can be challenging for the mental health of both partners and place strain on their relationship.

Any injury to the penis should be attended to by a doctor to make sure that there’s no underlying problem or trouble with healing.

Circumcision

Circumcision is when the foreskin over the glans (head) of the penis is surgically removed. Circumcision was most prevalent in the 1970s with the majority of baby boys having the procedure, so it’s more common in older men than younger men.

Some males are circumcised in adolescence or adulthood to treat phimosis — a condition in which it is not possible to pull the foreskin back over the glans.

Circumcised men are less likely than uncircumcised men to get urinary tract infections, inflammation of the glans of the penis (and/or foreskin) or get penile cancer (although this is very rare). It’s important for uncircumcised males to clean under their foreskin regularly.

Circumcision does not affect sexual function.

Sexually transmitted infections (STIs)

A sexually transmitted infection (STI) is an infection you get or give during sexual activity. STIs can be caused by viruses (e.g., human immunodeficiency virus, herpes), bacteria (e.g., gonorrhea, syphilis) or parasites (e.g., pubic lice).

Not all sexually transmitted infections cause symptoms, but some can cause rashes, bumps, or sores on and around the genitals. It’s possible for males to show no sign of infection with STIs that can have serious implications for a couple’s fertility.

That’s why it’s best to have regular (3-monthly) sexual health checks if you have a new sexual partner, regardless of whether either of you have any symptoms or signs.

Spots, lumps and bumps

There are lots of different variations in the skin of the genitals but both you and your partner need to see your doctor if you notice any spots or lumps. A doctor can make an accurate diagnosis and rule out anything serious. Soreness, redness or swelling of the penis should be seen by a doctor as soon as possible.

Pearly penile papules

Pearly penile papules are painless, dome-shaped bumps that usually occur in one or more rows along the corona (the rounded border where the head of the penis meets the shaft). They can be flesh-coloured or white and can look like small pimples or skin tags. Pearly penile papules are common types of bumps that occur on the penis, affecting between 1 in 7 to almost half of all men. They are a normal anatomical feature and do not require treatment.

Fordyce Spots

Fordyce spots are small, pale, slightly raised spots, found on the scrotum. They can also be present on your lips or on the snide of your mouth. They’re a type of sebaceous gland and are completely normal. About 4 out of 5 people have them and they’re not infectious.

Lichen sclerosis

Lichen sclerosis (sometimes called balanitis xerotica obliterans, or BOX) is a skin problem that causes white patches on the foreskin and glans of the penis, probably caused by to ongoing irritation or inflammation. It occurs in about 1 in 1000 men. In some cases, the white patches are painless but in others can be painful, itchy or have altered sensation. Lichen sclerosis won’t go away on its own and can lead to serious problems, so it requires a visit to the doctor. Men who are obese, or who smoke or have cardiovascular disease, are more likely to get lichen sclerosis than men without these risk factors.

Molluscum contagiosum

Molluscum contagiosum is the name of a skin condition (and the virus that causes it) transmitted by skin-to-skin contact, or shared towels or other similar items. It causes pale white, yellow or pink dome-shaped bumps with a ‘pit’ in the middle, that occur in groups of up to 30. The bumps are 2-5 mm across. Unlike some other sexually transmitted infections, using condoms does not prevent transmission of Molluscum contagiosum.

The scrotum and its contents

The scrotum is the pouch of skin that hangs below and just behind the penis and contains the testes (some people call them testicles). In some men, one or both testes may be able to move up, out of the scrotum and into the abdominal cavity. This condition should be checked by a doctor to make sure there are no associated problems with fertility.

Males can get cysts, varicose veins and other lumps within the structures contained in the scrotum. In most cases, these are nothing to worry about but if something is noticeable, it’s worth a trip to the doctor.

Your partner should perform regular testicular self-examinations to check for lumps, much like females check their breasts. Although testicular cancer is relatively rare, it can be deadly. But if it’s detected early enough, testicular cancer can usually be cured.

The diverse appearance of peoples’ genitalia is just the same as many other differences in physical appearance. If there’s something about the appearance of your or your partner’s genitalia that you don’t really like, it might help to speak to each other about it, or talk to a sexual health specialist.

If you notice any change in the appearance of your genitals or that of your partner, or if you notice anything that looks or feels abnormal, you should see your doctor.

What is Klinefelter syndrome?

Klinefelter syndrome is a common condition in which a male is born with an extra X chromosome.

The collection of chromosomes in your cells is known as its karyotype. The usual human karyotype is 22 pairs of chromosomes called autosomes, which are the same in males and females, and a pair of sex chromosomes. This results in a total of 46 chromosomes. Normally, women have 44 autosomes and two X chromosomes (denoted 46,XX) and men have 44 autosomes, one X and one Y (46,XY).

But with Klinefelter syndrome, a person is born with an X and Y chromosomes and an extra X, which is why the condition is also referred to as 47,XXY. The X chromosome is not a “female” chromosome and boys and men with Klinefelter syndrome are genetically male.

Around one in 500 men have Klinefelter syndrome and for many, it often goes undiagnosed. For some men, Klinefelter syndrome is discovered when they try to start a family. This is because even for those with mild symptoms, most men with Klinefelter syndrome produce very few or no sperm and are infertile.

 

Learn more about Klinefelter syndrome on our health topic page.

 

What are the symptoms of Klinefelter syndrome?

The effects of Klinefelter syndrome can vary quite a bit between different people. Sometimes symptoms of Klinefelter syndrome can be so mild in some individuals that they, their parents, partners, and their doctors may not even realise they have the condition.

Klinefelter syndrome is the most common cause of male hypogonadism, a condition where men are unable to produce enough of the male hormone, testosterone, for the body’s needs. Testosterone is important for the physical changes that happen during male puberty, such as development of the penis and testes, and for the features typical of adult men such as facial and body hair.

Testosterone also acts on cells in the testes to make sperm and is also important for overall good health. It helps the growth of bones and muscles, and it affects mood, libido (sex drive), and certain aspects of mental ability.

If your partner is severely affected by Klinefelter syndrome, they might have been born with:

Symptoms in childhood include:

  • Small testes
  • Long legs and tall stature
  • More body fat than normal
  • Difficulties with speaking, learning, behaviour, and socialising.

Boys with Klinefelter syndrome might begin puberty but then it stops, and have signs of low testosterone, such as:

  • Gynaecomastia
  • Reduced growth of the testes and penis
  • Reduced masculinisation of their bodies (e.g. reduced development of facial and body hair, reduced muscle, and bone development).
What causes Klinefelter syndrome?

Even though Klinefelter syndrome is a genetic condition, it’s usually not inherited. The symptoms of Klinefelter syndrome are caused by lower-than-normal production of testosterone by the body and the effects on development and function of extra copies of some of the genes on the X chromosomes.

If your partner has Klinefelter syndrome it’s important to get an accurate diagnosis and ongoing specialist treatment managed by their general practitioner. Klinefelter syndrome is associated with several health problems, mainly due to reduced testosterone levels, which are usually successfully treated by testosterone therapy.

People with Klinefelter syndrome are more likely than those without to have psychosexual and social problems, obesity, metabolic disease (e.g. type 2 diabetes), cardiovascular disease, some forms of cancer, autoimmune disease (e.g. multiple sclerosis, lupus), poor vision, dental problems, and blood clots.

Although there is no cure for Klinefelter syndrome, treatment with testosterone to maintain normal levels minimises the risk of health problems. Therapy provided by a psychologist may help people with Klinefelter syndrome with their emotional stability and self-regulation.

What a person with Klinefelter syndrome could be feeling

Symptoms of Klinefelter syndrome can greatly impact some men’s lives and barely interfere with others. There are useful online resources to help us understand what it’s like to have Klinefelter syndrome but there’s not been a lot of research on the subject. Being diagnosed with Klinefelter syndrome can be a relief (because there’s confirmation that something’s different from normal) but may also raise concerns, particularly related to effects on future health and fertility.

Helping someone with Klinefelter syndrome to be diagnosed, and to receive long-term care from a coordinated group of health professionals, will probably make a strong contribution to improving their life.

Although the related issues sound severe and a quick Google search offers overwhelmingly negative information, with the right medical care and ongoing support men with Klinefelter syndrome can lead normal, healthy lives.

What you could be feeling

There is no research on how Klinefelter syndrome impacts the partners of those diagnosed. However, associated issues of depression, anxiety, psychosexual problems and social issues can impact loved ones too.

Infertility can also be a cause of distress. It might be possible for people whose fertility is affected by Klinefelter syndrome to have children using assisted reproductive technology (ART). Common alternatives to starting a family include donor sperm with IUI or IVF, adoption, and micro-TESE surgery.

What you can do about Klinefelter syndrome

Men with Klinefelter syndrome must be properly diagnosed, treated, and monitored. Encourage your partner to see their doctor and an endocrinologist, and that they continue to manage their treatment.

If you want to start a family, chat with your GP. If your GP seems unsure of the best course of action, it’s okay to ask for a referral to someone else or to seek a second opinion.

Hearing from or meeting with other men with Klinefelter syndrome could be helpful for you and your partner. Organisations like Living with XXY have a strong community and a range of resources that raise awareness about the condition with a strong focus on the positive.

 

Learn more about Klinefelter syndrome on our health topic page.

What is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?

Prostatitis is inflammation of the prostate gland — a reproductive organ that sits below the bladder and makes fluid that mixes with sperm to create semen. There are different types of prostatitis and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) the most common, making up 80-90% of cases.

Symptoms of CP/CPPS vary and can include:

People with CP/CPPS have long term pain that lasts for at least three to six months.

CP/CPPS is different than acute or chronic bacterial prostatitis because there is no detectable infection, and the cause is often unknown. The variety of symptoms different men experience can make it difficult to diagnosis and treat.

What causes CP/CPPS?

The cause of CP/CPPS is usually not known. It is believed to originate from infection, injury, muscular or psychological causes.

What someone with CP/CPPS could be feeling

Diagnosing and treating CP/CPPS can take time and the symptoms can take a physical and mental toll. CP/CPPS can reduce a person’s quality of life and affect their personal relationships.

The more severe CP/CPPS is, the more likely your partner will experience pain catastrophising (dwelling on, magnifying or feeling helpless about the pain), depression, anxiety, and stress. Common symptoms of CP/CPPS, like LUTS and erectile dysfunction, may contribute to anxiety, depression, and stress. In addition to feeling frustrated and hopeless, your partner might also feel embarrassed about dealing with a condition affecting an area that can be uncomfortable to discuss.

What you might be feeling

If your partner has CP/CPPS, it can affect both of your sexual function and satisfaction, as well as your relationship more generally. The condition’s impact on your partner’s mental health can also affect you. It’s important to acknowledge the feelings you have about your partner’s symptoms and take care of your wellbeing too.

What you can do about CP/CPPS

If you think your partner’s CP/CPPS is affecting you, it might be good for you to speak about it with your doctor.

Although chronic pain can be difficult to treat, there are medications or other treatments (e.g., acupuncture, shockwave therapy) that might be effective.

The psychological effects of CP/CPPS might get worse the longer it goes on, so encouraging your partner to seek help sooner rather than later is important.

What is male infertility?

Male infertility usually refers to a situation in which the cause of a couple’s infertility is a problem with spermatogenesis or the movement of sperm through the male reproductive system.

 

Learn more about male infertility on our health topic page.

 

How common is male infertility?

We don’t always know the reason why some couples are infertile.

Most experts believe (based on their own experience and limited scientific data):

  • For 1 in 5 infertile couples (those who do not conceive a pregnancy after 12 months of trying), male infertility is the cause
  • For 1 in 3 infertile couples, female infertility (due to problems with the menstrual cycle, ovulation or reproductive system) is the cause
  • For about 1 in 3 infertile couples, male and female factors probably contribute

If you’re seeking help to conceive, both partners should have their fertility investigated from the beginning because male factors contribute to many cases of couples’ infertility.

 

What causes male infertility?

Male infertility can be caused by problems that affect sperm production or how the sperm move.

Problems with sperm include:

  • Azoospermia (when the semen doesn’t contain any sperm)
  • Oligospermia (low sperm count)
  • Abnormal shape (which affects the sperm’s ability to fertilise the egg)
  • Poor motility (which affects the sperm’s ability to swim)

These can be caused by:

  • Genetic conditions like Klinefelter syndrome (47 XXY)
  • Non-genetic conditions like varicocele, testicular inflammation or injury
  • Severe illness or infection
  • Some medications
  • Undescended testes
  • Abnormal hormonal function (due to genetics, infection, a cancerous or non-cancerous tumour, or a consequence of surgery)
  • Testosterone therapy
  • Abuse of anabolic steroids
  • Obesity
  • Age
  • Alcohol use
  • Smoking
  • Exposure to high temperatures (like saunas or occupational exposures)

Transport of sperm can be prevented by abnormalities in development that result in some parts of the male reproductive tract not developing at all, such as in men with congenital bilateral absence of the vas deferens. Other men may have blockages in their reproductive tract because of scarring or accidental injury during surgery or for unknown reasons.

Ejaculation problems and erectile dysfunction can be causes of male infertility.

Some types of cancer treatment can affect men’s fertility. Collection and storage of a semen sample are possible before such treatments, so healthy sperm can be used for in vitro fertilisation (IVF).

 

How is male infertility diagnosed?

To diagnose male infertility a semen sample will be analysed to look at the number of sperm, their size and shape, and their movement. A blood sample may be taken to measure hormone levels.

It may be necessary to test for infections or to look at the testes using an ultrasound scan. In some instances, a biopsy of the testes might be required.

Investigation of male fertility should occur at the beginning of investigations into a couple’s infertility, at the same time as investigations into the female partner’s fertility. Without a proper assessment of a male partner’s fertility, there is a risk of unnecessary investigations and treatment of female partners.

 

What your partner might be feeling

When it comes to fertility testing, your partner might feel embarrassed, uncomfortable, and anxious about the process. They might feel like it questions their virility, manhood, or masculinity.

The emotional response to a diagnosis of male factor infertility varies from person to person. Men can experience depression and psychological distress if they’re unable to have children. If male infertility is responsible for a couple being unable to have children, the male partner may feel a sense of failure, and a greater sense of loss, stigma, and low self-esteem than if a female factor is a cause.

These feelings might be expressed as irritability, anger, withdrawal, or sadness. They might find it hard to communicate what they’re going through and feel isolated or alone. Seeking support through your fertility specialist, therapist, support groups, as well as being open with friends and family may help.

Couples who experience infertility may experience a strengthening of their relationship, perhaps due to their shared experience of difficulties conceiving. Some men’s concern for their partner’s wellbeing may enhance their relationships. Men who do not hide their infertility, who express their feelings and seek advice, describe the greater strengthening of their relationship.

Support that’s tailored to the needs of both partners, that provides emotional support, information about treatment, and develops adaptive coping strategies should be provided to all couples.

 

What you might be feeling

Regardless of the underlying problem, a couple’s infertility affects both of you and it can impact your relationship.

Some women whose partners are infertile may be distressed by their partner’s emotional response or what seems to be resistance to investigations and treatment. Whether it’s a shoulder to lean on or some time alone — talk to your partner about what they need in terms of support and when.

Sexual function and satisfaction can decrease in men and women who experience infertility, but women tend to be affected more than men in this respect.

It’s important to acknowledge the feelings you have about infertility and take care of your wellbeing too. Chat to your GP or a counsellor who will offer support and strategies for navigating the situation.

 

What you can do about infertility

Treatment for male infertility depends on the cause and your health care team will help you determine the next steps for starting or growing your family. Lifestyle changes, treatment of other medical conditions or surgery may be required. If these are unsuccessful, it may be possible to use assisted reproduction technology (ART) to help you to conceive.

It can be helpful to get on the same page with your partner about fertility treatments with an honest conversation about the physical, emotional, and financial factors involved. When discussing infertility, choose a time when you or your partner won’t feel particularly vulnerable, stressed, or uncomfortable. This could be during a walk or a drive, where you’re shoulder-to-shoulder rather than face-to-face. Avoid assigning blame and approach infertility as a team.

 

Learn more about male infertility on our health topic page.