Suzanne Andrews, 46, an occupational therapist near Daytona Beach, Fla., realized there was a problem the first time she and her husband, Glenn, 53, tried to make love.

She guessed it was ED, or erectile dysfunction, but didn’t know the cause, or the remedy. As the host of Functional Fitness, which airs on her local PBS station, WDSC TV, Andrews is used to solving challenges at work -- and she was equally determined to find a solution in the bedroom.

Erectile dysfunction, which affects an estimated 15 million to 30 million Americans and is more prevalent in men over 40, is defined as the inability to achieve or maintain an erection adequate for sexual function. It can be precipitated by medication, depression, stress, hormonal abnormalities, and other factors.

"It’s really common," says Ira Sharlip, MD, a urologist in the San Francisco area. "There is good evidence now that erectile dysfunction, in some cases, is a precursor or future marker for cardiovascular disease."
Sign of a Bigger Problem?

Sharlip recommends getting your guy evaluated for cardiovascular risk if there is a persistent erectile issue that lasts for three months or longer.

Recent research has also shown that ED may be linked to diabetes, high cholesterol, hypertension, as well as the early stages of heart disease, so encouraging your man to set up a checkup with his doctor is a good starting point.

"The problem is, there are men who don’t come in because of embarrassment and denial," Sharlip says. "If a man develops erectile dysfunction, he has a window of opportunity to make some lifestyle changes that may reduce his risk of having a heart attack."
How to Talk to Your Man About Sex

Every couple has issues in the bedroom, so that’s normal, says Marianne Brandon, PhD, clinical psychologist, sex therapist, and author of Reclaiming Desire.

"I would encourage her to acknowledge how normal it is to have some sexual concerns," Brandon says. "If she can say, ‘I know we have a great sex life and everyone has concerns,’ that’s going to help him feel less criticized."

If couples don’t talk about their concerns, those issues tend to gain momentum over time, Brandon says. "Even though those conversations can be difficult to start, think about the conversation as being good for the future of your relationship," she says.

Her advice: The most important thing is to start with praise.

Andrews followed that advice in talking with her husband and stressed that she wanted to work through it together. "I told him that I loved him," she says, "and it didn’t make him any less of a man because he had this problem. I said, ‘I’m going to be there for him and support him.’"

How to Talk to Your Man About Sex continued...

Experts say that ED is a couple’s problem and can be resolved by working together. Besides talking about it, you can offer to set up a doctor’s appointment for your partner, accompany him to a checkup, or prepare a list of questions to ask -- if he thinks that would be helpful.

Karin, 42, a teacher in Westchester County, N.Y., who asked that her last name not be published, says it took her a few weeks to work up the nerve to talk to her husband because she "didn’t want to hurt his ego."

She researched the subject online and brushed up on the medical condition before broaching the topic. Having the talk was "a bit difficult," she says, "but I came prepared. I made it very clear that it wasn't about him, but rather about his cardiovascular system."

"He took it well," she says. "We have a great relationship, so he wasn't insulted, as he knew things weren't at their [best]."

Karin's effort paid off. After her husband focused on improving his cardiovascular functioning, the situation resolved itself within a couple of weeks.

Andrews says her husband tried taking Viagra and Cialis, which helped his ED but gave him bad headaches afterward. Plus the pills were expensive, she says.

As an alternative, she developed an intense workout plan to help him shed 20 pounds, adopt a Mediterranean diet, and improve his circulation. They worked out five days a week for 12 weeks and saw a noticeable improvement in their sex life.

"It’s not a quick fix like a pill," Andrews says, "But the benefits are long-lasting. He had more energy and felt better. Now it’s really a lifestyle."
Improving Your Sex Life

Difficulty with erection can be a metaphor for what’s happening in a man’s life, says sex therapist Brandon. "If he is feeling like he can’t succeed, that can be played out sexually. And if he’s got performance anxiety, that’s going to make it worse."

Try to be less goal-oriented about sex, she says, "and let go of the traditional notion that intercourse is what making love is all about and it’s got to end in orgasm."

To explore other possibilities, she recommends saying to your partner, "I would love to try more foreplay, experiment with different kinds of touch, or learn how to feel more pleasure."

If your goal is pleasure, she says, then it becomes less about his erection.

"There was a lot of pressure," Andrews recalls. "So we just decided to take the pressure off and not worry about it. We would just have fun and enjoy."

Think in terms of creating an ongoing dialogue about your sex life, Brandon says, and schedule a follow-up talk with your partner.

Improving Your Sex Life continued...

"Often, when there’s a sexual concern, the issue is actually bigger than sex," she says. "It can relate to people’s ability to connect emotionally and their feelings of satisfaction. Couples who are more sexually satisfied feel more satisfied with their marriages -- and with their lives."

If you arm yourself with the right information and plan your approach carefully in talking to your partner, dealing with ED may provide a much-needed boost to your relationship -- in and out of the bedroom.