My sister (35F) suspects her husband (39M) is cheating. I don’t know what to tell her.

This is a throwaway account. I can’t risk this being linked to me or my family.

I’m 24F, living with my parents in a Southeast Asian country. Our family is very religious and conservative. I have an older sister, Janice (35F), married to James (39M) for almost 10 years. They have a 5-year-old son.

This past weekend we had a big local festival. After the celebrations, Janice went to rest in her old room (now a guest room). I’d left my iPad charger there the night before and went to grab it. The door was slightly open, so I knocked and called her name. No answer. She wasn’t in bed, so I figured she might be in the bathroom or backyard.

Then I heard a woman crying from the bathroom. It was her. I panicked, thinking she’d hurt herself, and knocked. She opened the door and immediately said, “Please don’t” when I asked if I should call Mom or our aunt. She was dressed as before, but her face was puffed up and her makeup ruined. I’d never seen her look like that, completely broken.

After a lot of reassurance that I wouldn’t tell anyone, she finally opened up. She suspects James is cheating.

I was skeptical at first. James has had erectile dysfunction for their entire marriage. They’ve tried medication, diet, exercise, fertility treatments, everything. Their son was considered a miracle. They’ve barely been intimate in the five years since his birth.

Here’s why she suspects him:

1. Increased travel. He’s in a high-level corporate job that used to require 2–3 work trips per quarter. In the past two years, that’s doubled. He’s gone 2–3 months a year now. When home, he often spends weekends away with friends instead of with her.
2. The condom incident. A few months ago, she got a grocery delivery he ordered. In it was a pack of condoms. They haven’t been physically intimate for awhile at that point. He first claimed it must’ve been a freebie or mistake. She checked the order history and it was listed as purchased. Then he said he might’ve accidentally added it to the cart. He never reassured her or addressed her concerns, and she let it go.
3. Blood in underwear. Last week, while doing laundry, she found blood stains inside one of his underwear. When she confronted him, he looked startled and said it was from a groin injury.
4. Emotional distance. For the past 6 months, he’s been picking fights and pulling away emotionally.

She’s devastated. I’ve never seen her like this. I don’t know what to say or do for her. I’m especially confused about the blood in his underwear. What could that even mean?

What do you think? Could she be right about him cheating? Or is there something else going on here?

TL;DR: My sister (35F) thinks her husband (39M) is cheating despite having ED their whole marriage and almost no intimacy in 5 years. Recently he’s been traveling a lot more, avoiding her on weekends, once “accidentally” bought condoms, had unexplained blood stains in his underwear, and has grown emotionally distant. She’s heartbroken and I don’t know if she’s right or if there could be another explanation.