By Marc Braman, MD, MPH

MB (Marc Braman, MD, MPH):
If you have been around animals for any period of time, you probably recognize any dog, rabbit, or guinea pig can hump another of its own kind. On a purely physical level the mechanics of the sex act can work just fine with no real relationship for animals and even humans — at least for most guys, it would seem. But humans are relatively unique in how large a part quality relationship plays in good sex.

The science of sex — and yes, people have studied the intricacies of human sex in detail — is very clear. If you want really good, satisfying, regular sex it happens best in stable, committed, safe, functional relationships.

Many in today’s society are obsessed with movie or music stars. The tabloids are full of the latest hookups, relationships, breakups, and so on of the rich and famous. The whole world follows as the most beautiful and successful people on the planet get together, and…usually…eventually break up. Now, think about that for a minute. Imagine you are married to a woman voted the “sexiest on earth”. She is gorgeous…physically perfect. Every male on the planet is jealous of you. And you stop having sex with her. Why? And why would you want to stop sharing the same bed, bathroom, and so forth, and stop living together in the same house? Why would you want to divorce the “sexiest woman on earth”?

Life is actually, ultimately all about relationships. Sex is supposed to be a fantastic part of a really satisfying relationship. It’s not that a relationship is supposed to be an accessory to sex. Researchers from all different areas of science on human existence end up concluding that “connection” and “relationship” is how we are wired, and what we are here for.

Yes, we can and should look at sex and ED through the lens of what works best biologically for reproduction to understand why things do and don’t work. But all of this biology is to support healthy relationships, not relationships being an excuse to have sex — as many would seem to have us believe. The sex-first approach simply doesn’t work long term. The healthy person and relationship-first approach does.

Clinicians that specialize in sexual dysfunction are well aware that a lot of sexual dysfunction is based in relationship problems. They are all too aware that most try to solve their problems with a pill, while missing that the missing connections between human beings is the real issue. A woman that is shown real care and affection as a valued partner is much more inclined to want to have sex and have it with passion, than one who is treated poorly and then expected to satisfy a man’s sexual desires. Or if a woman is mean and horrible to you, how much do you want to be tender and intimate with her? Probably not much.

Why would you want to take your rocket ship to the moon if the moon is hostile toward you? You wouldn’t. One of the most common and effective ways of grounding your sex life rocket ship is bad relationship issues between you and your partner.

If you are having problems with ED, take a good look at your relationship. What is the quality of the relationship from your partners perspective? Focus on real love, and the sexual part of your love life will follow.

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Assessment of the relational factor in male patients consulting for sexual dysfunction: the concept of couple sexual dysfunction. Corona G, Petrone L, Mannucci E, Magini A, Lotti F, Ricca V, Chiarini V, Forti G, Maggi M. J Androl. 2006 Nov-Dec;27(6):795-801. Epub 2006 Jun 28.

The impotent couple: low desire. Corona G, Petrone L, Mannucci E, Ricca V, Balercia G, Giommi R, Forti G, Maggi M. Int J Androl. 2005 Dec;28 Suppl 2:46-52. Review.

Impairment of couple relationship in male patients with sexual dysfunction is associated with overt hypogonadism. Corona G, Mannucci E, Lotti F, Boddi V, Jannini EA, Fisher AD, Monami M, Sforza A, Forti G, Maggi M. J Sex Med. 2009 Sep;6(9):2591-600. doi: 10.1111/j.1743-6109.2009.01352.x. Epub 2009 Jun 9.

Treatment of male sexual dysfunction. Mohit Khera, MD, MBA, MPH, Glenn R Cunningham, MD. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. (Accessed on September 18, 2018.)

The Power of Vulnerability Brown, B. (2010, June) [Video File]. Retrieved from:

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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