I'm 44 and My wife and I have an active, healthy, and adventurous sex life. The problem is I can get a very good erection during foreplay or oral sex but when it comes to actual intercourse I lose my erection about 3/4 of the time which needless to say is extremely frustrating. I find my wife extremely attractive and I love having sex with her. We've been married 22 years and have never had issues in the past. We are very open and communicate about our sex life well. We have started getting into pegging and anal play to see if that helps, and it does for the most part, but sometime we just want to have sex and it doesn't work great when you are constantly going flaccid. If I manage to get PIV going on I will get an erection again and we finish as per normal, but that doesn't always work. I have some problems masturbating about 1/2 the time as well. I have been on anti depressants for 15 years, but we have lowered the dosages, or completely stopped, some of them and this is a more recent (18-24 month) problem. We have tried pauses between sex sessions of a week or more and that only helps about 1/2 the time. We also use condoms during intercourse to prevent pregnancy, but I've toyed with the idea of getting snipped. I guess my question is what can I do to alleviate this somewhat intermittent problem? Could it be low testosterone? Stress? The condoms? How do I approach my doctor? Do medications help, and can they be used long term? Any advice would be greatly appreciated. Thanks in advance.