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Hi. I'm 24 years old medical student. My problem starts 2.5 years ago when I was going to have sex with my girlfriend for the first time.I didn't have sex with anyone else before. Then when I supposed to I didn't got erection. The second time when we try the same thing happen again.Sometime I achieve erection but when the time comes to put condom the erection is rapidly gone.I start having problems with my sleep,with my studying,with my libido(it went down) e.t.c. When I know that we wouldn't going to have sex,my erection and ejaculation are OK.I went on psychiatrist and endocrinologist.My levels of testosterone and prolacine are OK(testosteron 14.32nmol/L,prolactin 11.85ng/ml).My morning erection is OK.So my problem is only psychological.First my psychiatric prescribe me venlafaxine XR 75mg 1x1 and diazepam 5mg 2x1 for two weeks.After this tretman I stop having problem sliping and my mood was better but my libido went zero.Then he prescribe me  lorazepam 1mg 1x1 but after one month the problem is still here.My libido is still low (I mastrubate once a week) and a still can't get erection for sex.I'm with the same girl almost 3 years.PLEASE ADVICE

[Janice M Epp, PhD]

Hi.

You're a medical student, so I'm sure you're aware that Lorazepam has many possible side effects, including decreased sexual interest and desire, as well as decreased erections. Although, as you say, most of your concern is emotional, this drug may also be interfering with your sexual response. Check with your physician to discuss an alternative that doesn't have sexual side effects.

Now, as to your emotional concerns:

Welcome to your 20’s! Erections go up and down. You’ll find this happening all your life. It doesn’t mean you can’t enjoy sex, but you have to let go of expectations of being a sexual superman all the time.

Much of your problem is due to your attitude. Once you experienced anything less than what to you is a “perfect” erection, you started feeling anxious and judging yourself, which can be a vicious circle. The more you worry about erections, the more your penis won’t cooperate. In fact, it can be downright rebellious! Many men feel that if their erection goes down even a tiny bit, there’s something wrong with them. Where does this come from?

Men receive so many messages that sex is about “performance” and pleasing a partner, rather than just enjoying the pleasure of it. Everything is goal-oriented—like a football game. The other message that many men receive is that sex is somehow dirty and wrong, unless you’re doing it for reproductive purposes. Sometimes this can creep into our unconscious thoughts and sabotage any pleasure. Ask yourself whether you have any conflicts about being sexual—any old messages that might be lurking in your subconscious. In addition, some men find that certain condoms limit sensation, and, of course, this can intensify with each experience, leading to more anxiety.

Your body is generally working fine—it’s your heart/brain that’s getting in the way once you’re fully awake.

Most importantly, stop thinking that good sex is dependent on a hard penis. Have fun, enjoy being touched and touching and let go of your anxiety and fear. For more information about erection issues, attitude, etc., I highly recommend the book “The New Male Sexuality” by Bernie Zilbergeld, Ph.D. It’s widely available online, both used and in paperback and is an invaluable resource.

Relax, stop putting pressure on yourself and enjoy sex for what it is: pleasure. Give yourself permission to enjoy whatever happens—and find partners who aren’t hung up on performance issues either. Best of luck to you. Dr. J