Dear Dr. Milrod:

I don’t generally have a problem with getting an erection. I can do it myself, and also when it comes to oral, there is no problem. However, when it comes to the act of coitus, there tends to be a little interruptus, if you know what I mean. Not sure whether wearing a condom has anything to do with this or not, and I completely understand the necessity for one when not being monogamous. But what can I do to alleviate it? I am in my 40’s, reasonably good shape, with a fertile mind, and eager libido. Please, help me.

Justaguy

Dear Justaguy:

1. See the doc and get a good workup. This includes a referral to a competent urologist. Don’t just take your General Practitioner’s diagnosis for granted. There can be a zillion things that even the urologist can’t pinpoint, but at least urologists have got a better track record in terms of penile issues. But there could be such diverse factors as high blood pressure, the beginnings of type II diabetes, cardiac issues, etc. Best to get everything thoroughly tested.

2. If you’ve never previously had erectile dysfunction while wearing a condom, it’s even more important that you go see a physician. If condoms have always bothered you, then maybe you could switch brand? And please don’t use condoms lubricated with spermicide, they can irritate the urethral opening and/or cause allergic reactions.

3. What does “reasonably good shape” mean? Ask yourself and compare with stats from 10 years ago. If all of a sudden you’ve packed on some pounds – that could certainly be a reason. Hit the gym, but don’t overdo it in the beginning, please.

4. Performance anxiety is a biggie! Does this happen with sex partners familiar to you, or is it with women you’ve never seen before? The penis is subject to the big guy upstairs [literally and figuratively, whether it’s your cerebrum or what people call God, morality, inhibitions due to early experiences, etc.] Practicing relaxation exercises before coitus is always a good idea. Getting with the same lady a few times over may also help. And please do not masturbate before visiting with a lady. For some, that just kills the deal, particularly if you’re of a more mature age where the penis needs more rest inbetween upticks. In fact, I wish a lot of you frisky, older boys would just lay off the pipe and have patience before the real thing.

5. Do any mind/mood-altering substances figure into the equation? Wining and dining can kill erections like crazy. But so can intense exercise to the point of fatigue. Moderation is key. And any drugs, alcohol or tobacco prior to a sexual encounter are absolute no-no’s when you’re dealing with erectile difficulties. You need to be clean as a whistle.

6. Yes, age. “In my 40s” is not “in my 20s.” Your penis may need some new motor oil, in the form of ED meds to sustain an erection. Again, please see the doc. And no experimenting on your own, please. These are prescription meds for a reason.

Christine Milrod, Ph.D.