Sex can be a humorous subject - some suggest something even of a Divine joke. Thus it is not surprising that those who suffer from sexual dysfunction can be the source of jokes- and none more so than those who experience erectile dysfunction (ED). This disability, however, is no laughing matter.

Sex is very important to us for a variety of reasons. Freud believed that instinctual drives originate in bodily needs that require gratification. We further need to preserve life and perpetuate the species through sexual satisfaction, the forerunner of procreation; ED threatens all this.

Psychologists, theorists and gynaecologists maintain that an enjoyable sex life is at least desirable, and probably essential for psychological wholeness. Magazines investigate our sexual activities, tabloids use page three models, bill-posters scream sex. While for the woman sex may be seen as an expression of love, for the male (the hunter), sex is essential for an additional reason: masculine identity is connected to sexual potency and procreation potential. Thus, understandably, ED constitutes a threat to the perceived masculinity of the man - his identity is threatened, his self-perception and relationships will be affected.

Unfortunately simple gestures of affection, not normally considered as preludes to sex, are constant reminders that sex is not an option. The male may fear intimacy, lest he be pushed into a sexual scenario, which has nowhere to go other than towards failure and dismay. Intimate gestures are feared and then avoided altogether. Thus partners may be concerned they are unattractive or that the men are being unfaithful. The ensuing distress and stress may affect the partners' self-esteem, and induce in them anxiety and depression. Nevertheless, but I think exceptionally, some couples may remain very close with excellent channels of communication. They may discuss and partially resolve the problem, maintaining some sexual activity and/or intimacy despite ED. However wives of males with ED are likely to blame husbands who experience guilt and resentment.

Thus ED involves considerable stress and one of the bulwarks against stress is absent in the ED sufferer - control. With ED, control over the physical element required for intercourse depends on artificial means and there is the constant threat of failure. Control is retaken by withdrawing from the partner and eliminating attempts to have intercourse. It is not surprising that studies suggest a strong association between ED and psychological disturbance - for instance, manifested in depressive symptoms.

In addition in response to stress - which in itself is related to ill health - couples may smoke and drink more and in other ways undermine their health. This may lead to time off work and a drain on health services. Thus there is a manifest need to take ED seriously and ensure that adequate financial resources are made available for research and treatment.

The recent past has seen chemical interventions which have hugely advanced the treatment of ED. Treatment, however, is far from simple. The temptation may be to hand out some pills and hope everything will get back to normal but medication, if effective, can be only a small step on the long road to recovery of a loving relationship.

The woman may have to be persuaded that returning to a sexual relationship is worthwhile and is connected to love rather than just physical action. The couple may have to start as if at the beginning of a new sexual relationship. The more "natural", the more "spontaneous" the process appears to be, the slower the seduction, then the more successful is the likely outcome.

A positive effect of a slow wine-and-dine wooing process may be that the man does not immediately associate medication with the ability to perform and gains confidence in his own ability.

Some may believe that ED is unimportant in the general picture of ill health. Some doctors, and, indeed, members of the public may feel that it is just one of those things and does not merit serious concern. However sex is properly seen as an essential part of our lives as humans. Moreover there are myriad hidden costs associated with the disorder. The use of interventions to solve the highly distressing problem of ED is therefore to be commended. It is important that interventions account for the complex dynamics of human sexual relationships and loving partnerships. Sex can be a demonstration of love. Everyone needs to be loved!