Libido and erection issue

Basically my situation is that I am a 23 year and I have noticed a decline in my sexual libido to the point where if I do not look at porn or have any stimulation in the presence of a woman I simply won't get an erection.  I could probably go for months without getting an erection if I don't look at porn.  I know for the past 2 weeks I have not looked at any porn or been around a female and thus have not had an erection or any sexual desire at all.  I do not feel depressed.  I am on a healthy eating diet, not over weight, and I do cardio 3x a week.  I also take vitamins, fish oil pills, as well as herbal supplements like Tribulus that are supposed to be known for increasing libido.  

When I AM with a female, I typically don't have any problems getting an initial erection, with foreplay and what not I can usually get a pretty hard erection nearly every time and when receiving oral sex I pretty much can keep it the entire time as well.  When I am having actual intercourse (always with a condom) however, I would say that 50% of the time I will lose erection if I do not manage to ejaculate within the first 5mins.  If I were to stop to change positions I would most certainly lose an erection.  When masturbating by myself I am able to keep an erection the entire time that I am looking at porn but if there is any disruption or break in me looking at it like needing to go to the bathroom then it often begins to weaken.  I have seen a doctor before about my testosterone levels and it apparently is normal.  Would something like Cialis help my problem?  How do I get a higher sex drive?  Even if it is a psychological ED what do I actually do to fix it?  I already know about "not needing to perform and just have fun" but that hasn't helped.  Why can I keep hard during oral sex but not vaginal?  What should I do?

[Janice M Epp, PhD]

Hello.

Cialis, Viagra, etc., don't create sexual desire. All they do is facilitate blood flow to the penis. And they're not a good long-term solution to non-physical problems.

And according to the FDA, various herbal concoctions like Tribulus have never been proven to actually increase sexual desire (except as a placebo).

Seems to me that something emotional is interfering with your desire. It's your job to figure out what that is. You're comfortable being stimulated orally, but for some reason, during penis-vagina sex (p-v), you're not as turned on, and you're easily distracted. So I wonder what p-v represents to you? Is there something about the intimacy of it that's disturbing or uncomfortable? And have always felt this way, or is it just with some partners?

Realize that sexual desire can be very tenuous and vulnerable to distractions. You might also examine what else has been happening in your life that may have affected you. Are you content with yourself, with your life, with your relationships? Are there any family or work crises?

Are you anxious around potential sex partners? Be aware that anxiety is the enemy of good sex. If you’re feeling anxious or unsure of yourself, your desire for sex will be affected. Or you may have conflicting feelings about being sexual, based on earlier issues in your life. Or you may actually FEEL desire, but suppress it, due to feeling conflicted. Are you aware of any reasons you may have for avoiding sex with others?

There could be other reasons you’re not turned on: 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. Some men are very affected by cultural or family messages that unmarried women who have sex are somehow “dirty” or evil.

So, to recap: you may have negative attitudes about sex in general, or you may have performance issues or be bored or frustrated. Think about the issues I’ve raised and see if any are true for you. Remember not to put pressure on yourself.

I’m wondering what YOU think is contributing to this and whether you’ve taken any actions to try to change it. You’ve probably got more insight than you realize. Best of luck. Dr. J