Almost half of Australian men will experience erectile dysfunction, but it's not something that's easy to talk about — or even acknowledge.
Matt Tilley, a clinical psychologist and lecturer in sexology at Curtin University, says it's a topic people often avoid discussing and it can be hard for partners to know how best to provide support.
"Both partners are involved, and both are affected. And the person without the sexual difficulty is likely to be part of the solution," Mr Tilley says.
So how can someone with a partner experiencing erectile dysfunction broach the subject, and best support them — in and outside the bedroom?
Erectile dysfunction explained
An estimated 40 per cent of Australian men experience erectile dysfunction (or ED) at some point in their life, according to the Royal Australian College of General Practitioners.
It's defined as the inability to attain or maintain an erection "sufficient to permit satisfactory sexual performance".
It's a confronting statistic, but Mr Tilley says it's important to know you can still have – and enjoy – sex without an erection.
We can cluster the many different causes of erectile dysfunction into two categories: physiological and psychological. A key risk factor is age, but younger men can experience ED too.
Physiological causes may include cardiovascular disease, diabetes and low testosterone – just to name a few.
Things such as smoking and medications can also impact someone's ability to achieve erection.
Depression, anxiety and stress are some examples of mental and emotional disruptions.
If you're experiencing problems, Mr Tilley says it's important to see a doctor to rule out any other underlying health issues.
How ED affects self-confidence
It's understandable that sexual dysfunction can affect someone's self-confidence.
Mr Tilley says people experiencing ED may avoid sexual experiences, which can feed a "negative sense of sexual self".
Partners of those with erectile dysfunction may also have their confidence rocked.
We recently received this email from a reader to the ABC Everyday inbox: "My husband is avoiding sex with me. I thought he was having an affair until I discovered he has erectile dysfunction."
Mr Tilley says it's not uncommon for people to assume their partner's erectile dysfunction is due to a lack of desire — even when this isn't the case.
"It can also be [incorrectly] mapped as evidence that the partner with erectile difficulties is cheating," he says.
How to help your partner manage their ED
Clinical and somatic sexologist and relationship counsellor Tanya Koens says it's important to check in with your partner.
Ask how they are doing, and let them know that if they are feeling distressed about the sexual dysfunction, "please don't on my account", she suggests.
Rather than "diagnosing" your partner, Mr Tilley says to instead approach the subject with an open mind and raise it at a time away from intimate moments.
"Reassure your partner they are not alone — you are there to assist in whatever capacity they want you to."
For example, offer to go with them to medical or therapy appointments, or search online for options.
"[That way] they can feel as though we are telling them they are not alone," he says.
If the conversation is shut down, Mr Tilley recommends pressing pause.
You could say: "It seems to be you don't want to talk about this right now, I didn't mean upset you, let's leave alone for now."
You can try again when the time feels right, he suggests.
Look for what is possible
Whether the person experiencing the sexual dysfunction is seeking treatment or not, exploring intimacy with a sense of curiosity will serve you both well, Ms Koens says.
"Look for what is possible, rather than what is not," she says.
"It's really pleasurable to discover other ways to have erotic energy with our partner."
Mr Tilley says it's a misconception that sexual needs can't be met without an erection.
"It's important to decouple the erection from the pleasurable sex. [For example] someone with erectile dysfunction can still experience orgasm," he says.
Making a 'back-up plan' for sex
Ms Koens says if a person is focusing on not being able to have or maintain an erection, it can take them out of the present and make sex stressful.
"When we are anxious, our brain will time travel us forward as if we are experiencing the thing we are afraid of," she says.
For that reason, she says it can be helpful for couples to come up with a plan that reduces the anxiety around that.
"We could shake hands and say, 'I'll see you here tomorrow'. We could kiss and see what happens," she says.
"We could have a shower together. We could play Scrabble. There are all sorts of things.
"But it's up to the couple to make the hit list of different ends to the story."
This article contains general information only. You should consider obtaining independent professional advice in relation to your particular circumstances.