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BACKGROUND: Many health professionals who deal with patients with erectile dysfunction (ED) vigorously promote the emotional concerns of the patient and the involvement of the couple in planning the management of ED. The importance of restoring penile erection as an isolated medical problem has been de-emphasized in recent years in favour of a more holistic approach to patient and partner. It is commonly accepted that support for the couple should enhance their satisfaction and compliance with therapy. METHODS: A prospective study was conducted to assess the attitudes of the patient and his partner toward a global approach to the diagnosis and the treatment of ED. After the initial consultation, a random sample of 100 consecutive heterosexual patients was asked to return with their partners for a full psychiatric and psychological evaluation. Information was collected during the interview and in counselling sessions. RESULTS: Although patients were asked to return with their partners, nearly 60 did not comply. In general, the attitude of the partner to the patient’s ED was that it was the patient’s problem, not hers. The partner’s attitude to sexual activity was often either one of indifference or a preference for no further sexual intercourse. In the majority of cases, the couple was either unaware of emotional problems in themselves or in the relationship, or were not prepared to disclose them. Less than 20% of those who did disclose the emotional problems agreed to attend further counselling, and even fewer (9%) did so. A persistent comment was that the availability of counselling did not affect the prime goal, which was restoration of penile function. In a considerable proportion (greater than 40%) of patients, alcohol and other substance abuse was identified as an important cofactor in the genesis of ED. In all these cases, further counselling was offered, but less than 5% of the patients accepted. CONCLUSIONS: Men with ED want to have a rigid penis. They and their partners show very limited interest in accepting help with relationship issues, general sexual issues and lifestyle issues (eg, smoking and alcohol), even if professional judgement and clinical evidence point to the major importance of these factors in influencing sexual outcomes.