It's a man's problem, isn't it? Certainly it is. But it's a woman's despair especially because, says Fiona Hanlock, very often there is much more lost than just the obvious.

Women have four different reactions to a man's impotence, says Margaret Ramage, a sexual relationship therapist. First is a feeling that she is not attractive enough or sexy enough. Second is suspicion, the conviction that her partner must be having an affair. "I was sure my partner was seeing someone else," said 30-year-old Susan. "We'd always had a great sex life and then suddenly it stopped, just like that. I was always accusing him, and he would promise me that he had nothing on the side, but I honestly couldn't believe him."

Third is the feeling of relief if the woman never enjoyed sex in the first place. "Sometimes it can be a relief for both partners," says Margaret Ramage. "Some people are no good at making love and never have been and struggle with it throughout their married life, thinking it has to be done because that's what's expected of you in a marriage."

And fourth is the feat that there's something seriously wrong with her man - that he must be suffering from diabetes, or working too hard.

"My husband's been to see three sex therapists," says 49-year-old Jane, married to a man who has been impotent for eight years. "None of them ever wanted to see me, despite the fact that impotency is a joint problem suffered by both partners, not just one. One doctor said to my husband, `Well, she's 49, so why is she bothered?' Can you believe it? I have felt so terribly rejected. I would cuddle up to him and make all kinds of efforts, but was just pushed away. I didn't feel feminine any more. I'm a businesswoman and I can take most things but this really floors me. Most people don't realise that impotency doesn't just mean the inability to have intercourse. My husband has also lost all desire. So kissing is not even sensuous."

"It's extremely important that both partners come for counselling," says Margaret Ramage. "Often the women are more in need of it than the men, but men are against their partners coming to therapy or counselling because they feel so ashamed and feel it's something they have to deal with on their own. They don't realise that sex has a lot more to do with intimacy than an erect penis or even bed. One couple came to me saying they had no sex life and yet they were sitting close, making eye contact, flirting and talking about things they used to do in bed. I said, `What do you mean you have no sex life? I can see it happening even now, in front of me. Just because you don't achieve penetration doesn't mean you have no sex life.' It's the partnerships in which all intimacy is cut out that often break up, not because of the lack of an erection."

Part of the problem is that some men, most of whom see sex in terms of performance, cannot understand that most women see sex in terms of their relationship. So to start with they may try to make love and fail, and then they get so discouraged and anxious that they cannot bear to be cuddly or even kiss for fear it will lead to sex and another failure.

"My man eventually withdrew completely," said Paula, who lived with an impotent man for a year. "First he refused to cuddle up, then he refused to kiss me, then he'd just sneak out of bed in the morning as quickly as possible to avoid any kind of contact. Then he started getting dressed and undressed in another room so I wouldn't see him naked. He stopped holding my hand and he even stopped calling me `darling'." Finally there was no intimacy left at all because he obviously felt that any kind of closeness might lead to a failure in performance, which he couldn't bear. We split up at that point. A therapist I saw said I was taking my man's anxieties on to my own shoulders, and it was his worries about his sexuality I was experiencing, not my own. But I did feel that up to a point I was having to damp down my own sexuality in the face of my partner's lack of potency, and that made me feel even more unsexy and resentful."

Nearly all men have periods of impotence after the age of 45. With long- term problems it's found that many cases of impotence have a medical basis, so partners are often right to worry that their men are ill. It turned out that Jane's husband had diabetes, though not before he'd been to one sex counsellor who encouraged him to ask his wife to "dress up in sexy clothes and have sex in unusual places, like in a country lane". It made me feel sick. He was then told to stop all caressing and touching for 10 weeks and then gradually to start massaging each other. All I wanted was for someone to actually talk to me. I was going through hell and back. The partner in impotence is totally ignored and any trauma you may be going through yourself with feelings of total rejection, isolation, lack of love, are just left for you to deal with. And what is worse is that because it is such a personal problem and you want to be loyal to your partner, you can't talk about it to anyone, not even family or friends."

What about other ways of having sex? Unfortunately, an impotent man is often reluctant to try this because any hint of sex reminds him of his failure and therefore, however kind and unselfish he may be, he can't bear to give his partner sexual pleasure manually because he believes that penetration, erection and orgasm is everything. "Anyway, other ways of having sex are not the same; you want to feel wanted," says Jane.

There are many more medical treatments on offer than there used to be. Injections can cause erections and even enable the man to ejaculate; vacuum pumps are more difficult to use, but they can often work successfully - they can make a man have an orgasm but not ejaculate. But many couples find them distasteful until they get used to them.

"The problem is that these treatments are not providing the cure they should," says Margaret Ramage. "They simply address the erection problem, when in fact women's anxieties should be addressed as well as men's."

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