My husband and I have been married for almost 16 years. Our sex life has definitely improved over the years. Before it was quantity, these last few years has been quality. We are both in our early forties and he seems to be having a problem maintaining an erection. Of course I thought he was no longer attracted to me, but he says he is and he is very concerned as well. I know this is not all about me and I really want to help us get through this tough time. I don't think that medication is the route he wants to take just yet and we are discussing talking with our doctor. Can you give me some additional information on the causes of erectile dysfunction. The sites I have checked are more for medicine and not education.

Erectile dysfunction is almost universal. This means that almost all men will experience it at some point. What is clear is that how a couple reacts to it is essential. It is essential that the women not take on his issue. It is typically not about attraction. As you probably know, a penis gets erect due to blood flow. There are several things that can and do interfere with blood flow. A loving accepting reaction is essential at this time. It is important that the female partner not "take it on". She needs to instead be loving and not blaming. Both partners need to make this "not a big deal". They need to remain connected and "romantic" as they discuss this occurrence. They both need to make this not anyone's fault. - Answer provided by Michael Gonzales, Ph.D., mfgonzal@speakeasy.net, www.upasoc.com.

What the 2 of you are experiencing is not that unusual. The first step I would suggest is that your husband see his doctor to make sure that there are no medical issues or medication issues that may be contributing to the erectile dysfunction. If the doctor reports that medically your husband is fine, I suggest trying the sensate focus technique. This technique asks the 2 of you to put intercourse on hold and to go back to discovering each others body and talking about what feels good. It also suggests that your husband not panic if he gains an erection and then loses it. The goal is to gain confidence in the idea that an erection can be had, go away and come back. Once confidence is gained here, the 2 of you can consider trying intercourse again. - Answer provided by Alan L. Marcus, Ph.D., AASECT Certified, drmarcus@tmail.com, www.gpatherapy.com.

It is not uncommon for men to begin to experience erectile difficulties in their forties. For some, just having one or two of these episodes can kick in a vicious cycle of anxiety that only serves to make things worse. First, I recommend that your husband talk to his doctor or see a urologist to rule out medical causes. Medical conditions like diabetes and cardiovascular disorders can cause erectile problems as men age. Once medical concerns are ruled out, I think it’s important to ‘normalize’ the fact that sometimes this may happen. Take the pressure off, don’t make such a big deal of it, don’t stop enjoying the pleasures of touch just because the penis isn’t getting as firm as it once did before. Normalizing this can help to alleviate any anxiety and can increase the likelihood of erection at some point during the sexual play. And it is possible to have ejaculation without erection. Erection makes penetration possible, but intercourse is not the only way to have a great time together. - Answer provided by Lynne Santiago, lynne@lynnesantiagolmhc.com, www.lynnesantiagolmhc.com.

Further information and advice on erectile dysfunction can be found here.

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