Although CME courses recommended that patient–partner–physician dialogue was best enhanced through patient–partner education during conjoint visits, there was anecdotal evidence that physicians were not regularly meeting with partners of sexual dysfunction patients. This author undertook a 2002 Internet survey of the Sexual Medicine Society of North America, member’s practice patterns. These urologists are all sub-specialists in sexual medicine in general, and erectile dysfunction in particular. Although methodologically limited, the results were interesting. The data pointed to a striking disparity between urologist attitude and actual practice. An overwhelming 79% of the responding urologists considered partner cooperation with erectile dysfunction treatment "important," regardless of whether the partner actually attended sessions or not? Yet, only 39% of the responding urologists saw only one partner or less in their last five erectile dysfunction patient’s office visits. Nor was there any contact by phone, e-mail, or other means between doctor and partners for 90% of the responding urologists, despite the vast majority of patients were married or coupled. However, there were good reasons for not having a conjoint visit, as long as the importance of partner issues in treatment success was understood. Indeed, many urologists reflected thoughtfully on the burden of the treater to not invade the privacy beyond what was freely accepted by the patient. Urologists noted that the men saw erectile dysfunction as their problem, and were not interested in involving their partner. These urologists gently encouraged partner attendance, but appropriately did not require it. So why are pharmaceutical erectile dysfunction treatments so effective? Does this data suggest that partner issues do not impact outcome? No, but it does support the thesis that "partner cooperation" is even more important than "partner attendance." Why are many physicians successful even when not seeing partners? Sex pharmaceuticals with sex counseling and education work for many people, if the partner was cooperative in the first place. Fortunately, many partners of both men and women are cooperative, which partially accounts for the high success rates of medical and surgical interventions. Indeed, most of the cooperation goes unexplored. The cooperation is assumed based on post hoc knowledge of success. Importantly, many women were cooperating with their partners, or facilitating sexual activity, independent of their knowledge of the use of a sexual aid or pharmaceutical. In other words, serendipitous matching of sexual pharmaceutical and previous sexual script equaled success: "we did, what we used to do, and it worked."

The existence of large numbers of cooperative, supportive women who themselves have partners with mild to severe erectile dysfunction account for much of the success of many erectile dysfunction patients who see their physicians alone, for evaluation and subsequent pharmacotherapy. Many of these partners were never seen by the treating physician, nor was their attendance necessary for success. This is likely to be true for other male and female dysfunctions as well, depending on the degree of psychosocial barriers to success. Obviously, the most pleasant, supportive, cooperative partners would rarely be discouraged from attending office visits with any patient. Ironically, these same patients would probably have successful outcomes even if their partners never attended an office visit. However, good becomes better by evaluating, understanding, and incorporating key partner issues into the treatment process.

The patient–partner–clinician dialogue is best enhanced through patient– partner education. Partner attendance during the office visit would allow for such education. Yet, many clinicians do not regularly meet with partners of sexual dysfunction patients. Although working with couples was often recommended: sometimes there was no partner; sometimes the current sexual partner was not the spouse, raising legal, social, and moral sequella. The reality and cost/benefit of partner participation is a legitimate issue for both the couple and the clinician, and not always a manifestation of resistance. Finally, the patient’s desire for his partner’s attendance may be mitigated by a variety of intrapsychic and interpersonal factors, which, at least initially, must be respected and heeded.

There are other solutions. When evaluation or follow-up reveals significant relationship issues, counseling the individual alone may help, but interacting with the partner will often increase success rates. If the partner refuses to attend, or the patient is unwilling or reluctant to encourage them; seek contact with the partner by telephone. Ask to be called, or for permission to call the partner. Most partners find it difficult to resist speaking "just once," about "potential goals" or "what’s wrong with their spouse." The contact provides opportunity for empathy and potential engagement in the treatment process, which may minimize resistance and improve further outcome. This effective approach could be modified depending on the clinician’s interest and time constraints. Clinicians should counsel partners when necessary and possible. They need to be a resource in treating with medication, counseling, and educational materials. Education needs to be a greater part of sexual dysfunction practice, whether provided within a physician’s practice or externally by other competent healthcare professionals. Success rates can be enhanced through patient–partner–clinician education, which will reduce the frequency of noncompliance and partner resistance, and minimize symptomatic relapse. Organic and psychological factors causing sexual dysfunction, and noncompliance with treatment, are on a multi-layered continuum. Although some partners will require direct professional intervention, many others could benefit from obtaining critical information from the sexual dysfunction patient and/or multiple media formats both private and public.