I'm 52 and I've been in a loving marriage for five years, but a couple of months before we were married my husband's libido collapsed. He's had tests, seen a therapist and tried Viagra without success. He says his body is saying no. I'm at my wits' endThe question is whether your husband’s impotence is of psychological or physical origins. When there is doubt, complex tests are needed to exclude a physical cause, but a carefully taken history gives a few clues.
It is important to know whether your husband still has nocturnal erections and, if so, if he also has wet dreams, or nocturnal emissions in medical jargon. If he doesn’t, when did they stop? Had they been becoming less frequent before he became impotent? Does your husband still have erotic dreams and, if so, what is his role in them and about whom is he fantasising? Is he still able to have an erection if he masturbates? If he can still have erections when he masturbates, or while he is asleep, his potency may be failing but he is not yet impotent. Waning potency so upsets some men that their self-esteem takes such a knock that they lose their prowess. If his erotic dreams are becoming less vivid it is likely that it is his libido that is decreasing. If your husband ejaculates when sexually excited, even if he doesn’t have an erection, it is likely, but not certain, that his impotence has a physical origin.
Is your husband taking any medication? A wide range of drugs may cause erectile dysfunction. Changing to another drug that performs a similar role may revolutionise the situation. Remember that tobacco is such a strong inhibitor of sexual response that it even weakens or prevents nocturnal erections. Does your husband drink much alcohol? There are good reasons why impotence is colloquially referred to as brewer’s droop.
Has your husband been married before? If so, were his sexual relations with his first wife initially satisfactory but then deteriorated or became non-existent? It is tempting to suppose that the cause of his impotence is psychological because there is a close association between it and your marriage. Victorian doctors made much of the madonna-and-whore complex. One of its manifestations is that a man’s attraction to a woman changes once married. The woman then ceases to be principally a sexual object and becomes a revered potential goddess, untouchable on a pedestal. However, this theory can be deceptive. Often it is other worries, tensions or guilt that are inhibiting the sexual response.
Your husband needs a full cardiovascular assessment. This is more than a blood pressure reading and a stethoscope waved over his chest. As a minimum, it includes an exercise ECG. Often the first sign of the arteries furring up is deteriorating sexual performance. Blood sugar levels should be measured to detect prediabetes, as well as actual diabetes. Cholesterol blood levels matter. Hormone assessments should be done, including testosterone, thyroid and prolactin levels. A full blood count is essential. If the erectile dysfunction is not the result of cardiovascular or hormonal changes and does not follow injury to the spine or pelvic nerves from trauma, surgery or irradiation, a neurological opinion is called for. Other diseases of the nerves can affect penile sensation and the erectile reflexes.
There is a statistical link between age and impotence: under 40, only 7.5 per cent of men suffer from it. At your husband’s age, 18 per cent do so; over 70, about 60 per cent are impotent. Although in three cases out of four impotence is the result of a physical cause, or a combination of both physical and psychological factors, one patient in five still feels embarrassed talking to his doctor about it. Well over 50 per cent don’t discuss it in detail with their partner, and one in four doesn’t talk to his partner about it at all, while one man in ten sleeps in a different room so that the problem doesn’t have to be confronted nightly.
Although lack of libido is often confused with impotence or erectile dysfunction, they are very different conditions. Men who suffer from low libido can often achieve erection but they have lost the desire to have sex, whereas men who suffer from impotence or erectile dysfunction want to have sex but can not achieve or maintain an erection long enough to do so. Erectile dysfunction is relatively common and affects about one man in every ten, but low libido in the human male is quite rare. On average, a GP will see one man suffering from lack of desire for every 15 suffering from erectile difficulties and, unlike erectile dysfunction, low sexual desire does not respond to Cialis, Levitra or Viagra.
Lack of libido can have a number of physical explanations. You would be hard pressed not to notice the more obvious culprits — alcoholism, drug abuse, diabetes or obesity — but “not tonight, darling” can also be a side-effect of prescription medications, particularly those used in the treatment of prostate problems and, less frequently, it may relate to low levels of testosterone, an excess of the hormone prolactin or anaemia.
That said, since your hubby has already been tested, referred to a therapist and prescribed Viagra, it sounds as if his GP has investigated and dismissed physical causes. This suggests that your husband’s sexual apathy probably has a psychological source. Could he be suffering from the modern plague, depression? Is he stressed, overworked or suffering from sexual hang-ups? Could he be confused about his sexual orientation or bored with your relationship? These are difficult questions to put to a woman who is, in all other aspects, happily married, but it is not normal for a man who has been hitched for only five years to have absolutely no sexual desire.
With no specific diagnosis, and no obvious course of action to take, I can see why you must be at your wits’ end. The congruity between the onset of his problems and the start of your marriage can’t exactly have been lost on you and no matter how nice he is, unless you have been blessed with unusually robust self-esteem, it must be difficult for you not to interpret this coincidence as a kind of personal rejection.
Most women in your situation that I have encountered find this aspect of low male libido the hardest to cope with. They often describe their husbands’ lack of desire as an embarrassing, humiliating experience which leaves them feeling “lovingly ignored”. They also talk about the loneliness of living in a “sham” marriage which looks perfect from the outside but feels empty on the inside.
Though it can be difficult to step back from something that has such an enormous impact on both of you, there is little that you can do to change your husband. However, you can, and should, change the way that you respond to the situation. Instead of tearing your hair out, calmly encourage him to eat well, to take exercise, drink less and quit smoking. Ask him to continue with therapy and request that he attends psychosexual counselling with you as well. Don’t nag or beg or blame yourself for this situation, and don’t neglect your personal needs.
If he continually refuses to get and to sustain appropriate professional help, you may have to brace yourself for the possibility that he is not prepared to invest in the sexual side of your marriage.
That sounds very doom and gloom, but how much it really matters depends on the extent of the mismatch between your libidos as you age. Although we all want to believe that we will remain sexual until we die, in truth, many couples nudging 60 prefer a nice cup of tea and a peck on the cheek.
OVER TO YOU
Do you have a sexual dilemma for Suzi Godson and Dr Thomas Stuttaford? Send your e-mails to body&soul@thetimes.co.uk or write to Body&Soul, The Times, 1 Pennington Street, London E98 1TT. The authors regret that, although your letters are much appreciated, they cannot respond personally.
