Dear Dr. Milrod:

The last few times I”ve met with my new girlfriend, I’ve been unable to get a decent erection. I take a daily Cialis pill;  I also take two separate blood pressure medications and one for cholesteral. Not sure if the BP meds are the problem or what. The thing is I can get a great erection when watching soft porn or with my former lady friend of almost 30 years. Is this all in my head ? My new, gorgeous, beautiful girlfriend (she is only 30) has tried everything, with the exception of going bareback (she can’t be on the Pill so we use condoms) – it’s just really frustrating for both of us. She is also a flight attendant, so it always feels like we don’t have much time to play.

San Diego, 60

Dear San Diego, 60:

Here are the culprits:

1. Your age

2. The blood pressure medications

3. The cholesterol medication

4. The condom, which I’m assuming you are using

As far as your former lady friend of almost 30 years – well, you could probably get yourself off with her in your sleep – you know exactly which buttons need to get pushed. With your brand new girlfriend added excitement can translate into unconscious performance anxiety, plus the factors above.

What to do:

1. Consult with your physician and tell him/her that you can’t get an erection and ask for a change in medications. Oftentimes, patients remain on the tried-and-true for years. Meanwhile, new products with less side effects come on the market; if you don’t tell your doc, however, s/he wll keep you on the things that work.

2. Watch some soft porn while you’re at it with your current girlfriend, in addition to doing as much uncovered as possible and as much as your risk tolerance permits. Please take things slow and relaxed – it’s difficult to get all sexed up against the pressure of doing things when you are racing against time.

3. Begin to exercise regularly which may raise your testosterone levels. High blood pressure tells me you’re not moving around enough – hard training is what raises T-levels naturally. Other than that, discuss T-supplementation with your physician if there is a need for it. The most important thing for erections is good vascular blood flow, which you promote by vigorous exercise, low blood pressure and good fat to lean tissue/muscle ratio. Cialis is not the end-all-be-all of erections.

Christine Milrod, Ph.D.