You want to know how I feel, I’ll tell you. I feel like an absolute nothing. I know I can satisfy her in other ways and I do, but that’s not the point. I feel like the masculine center has been taken out of me – Man, 51

I’m the one who feels impotent. I feel unattractive and undesirable because I can’t arouse the man I love. If this isn’t fixed soon, I’m the one who’s going to need pills … maybe Prozac. – Woman, 55

I feel like a new man, better than I have in years. Being able to function again sexually has given me a new outlook on life and made my marriage 100 percent better. – Man, 46

If you have difficulties with erections, you belong to a very large group of men. It is estimated that twenty million to thirty million Americans suffer from some kind of erection difficulty. Although erection problems are found at all ages, they become more common with age.

A recent study found that 52 percent of men between the ages of forty and seventy had some degree of erectile dysfunction. Knowing these statistics won’t fix your problem, but you may feel better knowing you have lots of company.

While any problem with sex is upsetting to a man, nothing generates as much concern, anxiety, shame, and despair as an inability to get or maintain erections. Nothing except the loss of his job can make a man feel less of a man.

A man in therapy said it like this: “I’ve never felt like this before. I just don’t feel like a whole person, and certainly not like a man.” Other men have used terms such as “useless” “hopeless,” “fraud” “lost my manhood,” and “can’t cut it anymore” to describe how they felt when their penises weren’t functioning.

His partner may be sympathetic and supportive, but he may be so consumed with self-criticism that he can’t accept what she offers. Many men distance themselves from their partners after such “failures” and engage in much self-reproach. The result is usually a miserable time for all concerned.

Given all the feelings men with erection problems have, clear thinking becomes difficult. Yet such thinking is exactly what’s necessary, because you have to make some decisions about how to deal with your situation. It may help you to feel better to realize that given the various treatment options available, there is almost certainly a solution for you.

There are a number of ways in which your penis may disappoint you. Almost all men have had at least a few experiences when they wanted an erection and didn’t get one or when they lost an erection at some embarrassing point. Some men have problems with getting or maintaining erections at the beginning of a relationship.

Then, after they become more comfortable with their new partners, erections become more reliable. Because these kinds of difficulties are common and transient, it’s best to view them as a part of life rather than as problems. And some men are now taking Viagra to help break the ice with a new partner.

There are also more chronic difficulties.. Some men usually have difficulty attaining erections, while others have trouble maintaining them.

For still other men, the problem is that their erections aren’t as hard as they would like. And there are men who don’t get erections at all, regardless of the kind of stimulation.

There are basically three ways to resolve erection problems. One consists of various medical, pharmaceutical, or mechanical interventions, the most recent and best-known of which is Viagra. The second is sex therapy, the third is a combination of the first two.

Before getting to these options, however, you need to know more about the nature of the problem.

Some erection problems are primarily physical or drug-related in nature, some are primarily psychological, and a majority have both physical and emotional components.

The cause does not necessarily dictate the treatment – you can try any treatment you want but this information can be very helpful. For instance, if your problem is due to a medicine you’re taking or to not having enough testosterone, going through sex therapy could be a waste of time. 

WHAT CHEMICALS ARE YOU PUTTING INTO YOUR BODY?

This includes any and all chemicals, including prescription and recreational drugs, alcohol, and nicotine. There are a host of drugs that contribute to erection problems.

If you are taking any of the suspected drugs, adjusting the dose or switching to another drug is possible. If you’re taking a recreational drug on the list, you should consider getting off it and at the same time look at the available medical and therapy interventions.

Don’t forget to consider your intake of alcohol. Social drinking or having “just a few drinks to relax” may inflame desire but kill erections.

Smoking tobacco is another risk factor to consider. Studies show that smoking contributes to the hardening and clogging of arteries, including the ones that supply blood to the penis. Smokers have far more potency problems than nonsmokers.

DO YOU DESIRE SEX WITH YOUR PARTNER, YOURSELF, OR ANYONE?

If your appetite for sex is intact, your hormones are probably in working order and there is no need to get tested.

But if your desire is low or nonexistent – if you don’t notice attractive women, don’t fantasize about sex, don’t want to masturbate or have sex with a partner – it may well be that your testosterone level is deficient. Testosterone is the desire hormone in both men and women.

When its level goes below normal, as it can for a number of reasons, desire significantly decreases or disappears. It’s difficult to have a functioning penis in the absence of desire.

If your desire and penis are both in the doldrums, you should schedule an appointment with your regular doctor or a urologist to get a blood test to determine your testosterone level. You need to talk openly with your doctor about the test results; if you think you’re getting a runaround, seek a second opinion. Supplemental testosterone is given by injection or gel or patches. Note: Although hormonal deficiencies account for only about 5 percent of erection problems, they are often overlooked, especially in young people.

When hormone injections or patches are used, the results are often quick and dramatic. “The difference between day and night” was how the wife of a client who previously had no interest or erections put it after his first testosterone injection. “In the past I couldn’t get him to have sex no matter what I did,” she continued. “Now he’s the one who says we can be late to work because we have better things to do first. I love it.”

A relative lack of desire and trouble with erections can also be the result of depression. By depression I mean a definite sense over a period of at least several weeks that life isn’t worth living and things aren’t going to get any better. (Other possible signs are increased irritability, diminished pleasure in activities that once were fun, increased or decreased appetite, decreased ability to concentrate on what you are doing, and any kind of sleep problem).

One of the signature attributes of depression is a loss of interest in sex and usually other things as well. If you or your partner think you are depressed, you should get yourself to a physician or therapist as quickly as possible. When the depression is treated with therapy or drugs, chance, are good your sexual desire and erections will return.

ARE YOU GETTING AND KEEPING ERECTIONS UNDER SOME CONDITIONS BUT NOT OTHERS?

If you have erections (firm enough for vaginal insertion but not necessarily hard as a rock) by yourself but not with a long term sexual partner, or with one partner but not another, or on vacation but not at home, this strongly suggests that the problem is not primarily physical in nature but instead has more to do with your feelings about one or all partners or your level of stress. This means you can choose any treatment option that you, your partner, your physician or therapist agree on.

DO YOU NEVER GET OR KEEP ERECTIONS UNDER ANY CIRCUMSTANCES?