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Here is some advice that can help you and your partner through this difficult time:

• Remember, no one is to blame. Assigning blame is always unproductive and often unjustified. Look to the future, not the past. Use your time and energy to get appropriate help solving the problem.

• Think in terms of we—not just he, or me. People who successfully overcome their difficulties work together as a team. They grow stronger as a couple as they confront and solve the problem.

Just examine Marianne’s story to find out how important these guidelines are.

Marianne, a 35-year-old personnel manager, has been happily married to Jack for almost a decade. If you asked her, she’d make no bones about describing herself as aggressive, smart and capable. She and Jack have had their ups and downs, but generally their marriage has been strong. Their friends call them a happy couple.

But their friends haven’t seen their private side. When Jack lost his ability to get an erection, Marianne felt threatened and blamed herself. Although she usually communicated well with her husband, she knew this subject upset him. Rather than make him more worried, she kept her feelings a secret for a long, painful time. The results were far-reaching. “I thought it was my fault—initially,” says Marianne. She had always been might mean the end of something important that she enjoyed, that also brought them close emotionally.

But in many ways, Marianne was fortunate. Jack, although hurting and depressed himself, was able to reach out to her and reassure her that she was not to blame for his difficulty, and that he still found her attractive and wanted her sexually. And Marianne had other responsibilities, like her job, that demanded much of her energy and prevented her from becoming obsessed with the sexual problem. And even though she was emotionally hurt, Marianne was determined not to let the erection difficulty create a barrier between her husband and herself. She made special efforts to let Jack know she cared about him and wanted to be physically close to him—intercourse or not.

Although Marianne was careful not to spend all of her time concentrating on the lack of potency, neither did she withdraw from her husband. She gave him plenty of affection and didn’t shy away from being physical with him.

And perhaps as important, she took an active role in getting help. She urged him to check whether there was a physical cause. As it turned out, tests showed that Jack did not have a physical cause for his lack of erection. What he did have was an overload of stress, anxiety and tension—feelings he had been keeping bottled up inside. Sex therapy turned out to be the right treatment.

Marianne’s openness and willingness to help were important to the sex therapy. She didn’t regard the erection problem as Jack’s alone, and she did not withdraw sexually. She examined her own expectations and beliefs. She worked to keep her tendency to blame herself from overwhelming her by encouraging her husband to seek a solution.

Marianne and Jack had a number of important things in their favor:

• They were very committed to each other.

• They had a history of a mutually satisfying and pleasurable sexual relationship,

• They made efforts to communicate with each other, although both felt bad.

• They sought help early on in the situation.

In short, they took an active stance instead of a passive approach.

Encouraging Jack to get an evaluation was a smart move on Marianne’s part. Sometimes knowing the cause makes it easier to cope with the problem, because it removes the stress of being in a state of limbo.

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Sometimes potency responds best to treatments only a doctor can give. Often these treatments are administered by your doctor in his office, with additional instructions that you follow at home. Other times surgery is necessary. Either way, medical treatments have restored potency to a lot of men— permanently. And there are a lot of treatments to choose from. Here’s the latest.

Penile Shots

It seems frightening, but it works wonders: the penile shot. Sticking a needle in your penis to get an erection might not be as romantic as a candlelit dinner and a snapping fire, but some men with potency problems are finding that the shots boost their sex lives. Once they learn the technique, they can use the injections at home when they want to make love.

Your reaction to even the thought of an injection in your penis is probably to shrink back. But really, there’s notvery much to worry about. Men report that the injection doesn’t hurt any more than any other type of shot—and the pain doesn’t last.

The needle is so small—about three quarters of an inch long and quite skinny—that the initial jab itself isn’t very painful. The needle is inserted into the side of the penis, about midway along the length of the organ. There is a slight burning sensation when the medicine is injected, but it quickly disappears.

The drug injected will usually be papaverine, or a combination of papaverine and phentolamine. These medications dilate the arteries in the penis, thereby increasing the blood flow to the organ. In addition, it appears that papaverine dilates the sinuses within the penis where the blood is trapped during an erection. Dilation of the sinuses compresses the veins so there’s less blood leaving the penis.

And a man with a papaverine erection won’t lose it when he ejaculates, because the drug will keep working. The man will still feel pleasure and may be able to ejaculate again, although the ejaculation might seem less intense. The erection will subside only as the medicine gradually leaves the penis and disperses throughout the body.

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Sometimes a man who’s desperate will insert some long, hard object into his penis, in the hopes that the organ will become erect around it. But there’s no such luck. Instead, in short order, the man is in great pain, in danger of developing an infection, and possessed of a great and immediate interest in getting the object out. However, he usually finds it’s impossible to remove the object on his own. Emergency room doctors can recount tales about the variety of objects they have removed from men’s penises: pens, pencils, eyedroppers, swizzle sticks and even animal penises are some of the items doctors have extracted from this sensitive area.

Inserting a foreign object into your penis will not produce an erection, but we can almost guarantee it will produce pain and soreness. Sometimes the object prevents a man from urinating, which can be a very dangerous situation. And for some unfortunate individuals, permanent injury to the penis results from infection or damage caused when the object is finally removed.

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Joe and Mary have been married for more than ten years, and each contributes to the family income. In their budget, each partner is allocated a certain amount of personal spending money. The rest of the money goes for joint expenses, like food, house payments and savings.

Suddenly, Joe is demoted at work, and his hours are cut. His paycheck suffers a huge reduction. Although the change at work isn’t Joe’s fault, and lots of other employees are similarly affected, Joe’s sense of self-worth is shot full of holes. He feels like less of a man.

Joe doesn’t tell his wife about the change in his situation and how bad it makes him feel. Without a word, he just cuts back on the amount he contributes to the family budget. He feels embarrassed, ashamed and guilty about his reduced participation, and he withdraws as much as possible. He doesn’t talk much to Mary. He refuses social invitations. He becomes quite depressed.

Naturally Mary reacts by worrying about the reduced household budget. Although she is filled with questions—Is Joe spending his money on someone else? Did he lose his job, or get reduced hours at work? Does he feel less love for her, and thus want to contribute less?—she is afraid to ask them.

Joe deals with Mary’s silence with his own set of unspoken questions. How is she coping with less money? Doesn’t she mind? Is she making up the difference by getting more money from someone else?

If this tension and anxiety increase and the situation is allowed to continue, it will develop a life of its own, with each partner attributing negative motives and feelings to the other. The once-positive relationship Joe and Mary enjoyed will be poisoned by their imaginations. But this does not have to happen. Simple questions and answers spoken early on, coupled with warmth and support, can break this communications deadlock. Joe and Mary can decide what they want to do about the change in their finances—together. The same applies to potency problems.

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TAKING A PILL to regain lost erectile function is an incredible development in the history of drug intervention. But the pill itself cannot obliterate the other problems a couple experiencing ED may have. In fact, in certain circumstances, it may even add to the existing issues with which the pair has had to cope.

One of my greatest concerns as a physician is that the new treatment for ED gives people an unrealistic expectation about their ability to immediately cure their emotional relationships along with their physical ones.

Nothing could be further from the truth.

It is no secret that men and women react differently to sex— before, during, and after it takes place. The availability of a new quick, painless treatment for ED can have one impact on men and quite another on women. Consider the comments I’ve heard in my office:

From a thirty-three-year-old man under tremendous work-related stress: “The pill is the best thing lhal could have happened to me.”

The comments of his partner, a twenty-nine-year-old lawyer who was equally busy: “Right now we can have the sex we want when time allows for it—which isn’t very often.”

From a fifty-two-year-old man whose extra poundage and drinking made ED a constant companion: “In one way I feel great because I can have sex again. But in another I feel awful, because I can’t hide behind my weight anymore.”

His fifty-four-year-old wife had a different view of the situation: “For the last five years his primary relationship has been with food. Now everything has changed and, frankly, I’m not happy about it. It sort of puts the focus on me now.”

A forty-six-year-old man, on the verge of a divorce after eight years of marriage, told me: “Ever since I found out that a drug could help me, I’ve wondered how to use it. Our marriage was based, to a large degree, on sex. For two years we’ve been trying to find other ways to communicate. We never did. Having the means to have sex again is wonderful—but I have to ask myself, what kind of relationship did we have in the first place?”

His forty-three-year-old wife concurred: “He’s right. It was a big reality check to see how little we had in common. Yes—I’d like to have sex with him again. But where do we go from there?”

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