anxiety based dysfunction

[geoff19208]

I'm a 42 year old male.  Up until my early thirties I had no problem performing during sex.  I didn't even think about getting an erection, it just happened.  However when I was 34, I was about to have intercourse and the thought that I may not be able to get an erection came into my mind and, hey presto, I didn't.  Ever since then it's mushroomed into a huge problem and I haven't had sex since.

I don't believe the issue is physiological as I don't have a problem getting and maintaining an erection when I am alone.  However the opportunities I have had for sex with a women since I was 34 have all been ruined by this anxiety.  It's a bit like insomnia: the minute one worries about getting to sleep, it's a certainty one won't.  Likewise I have been with women and done my best 'not to think about it' and of course bang, there goes the opportunity.

I have now met someone who I really want it to work with.  I know one option would be to tell her upfront and work through it with her but it's a big thing to impose on someone one doesn't know me that well and my personal belief is it doesn't reflect badly on the person if they can't handle it (also this person is about ten years younger than me).

Let's put aside that option and I will voice another idea.  I have tried Viagra once on my own and it performed as expected.  In fact it lasted a lot longer too.  Even the next day I was still able to get rock solid erections on demand.  I did lose them after orgasm though.  Assuming it does get to the point with this women that sex is a possibility, I was thinking I should use Viagra for the first one or two encounters to help ease the anxiety.  It may not vanish but at least the possibility of never performing will have been removed and I believe it's that first time that gets me especially anxious.

I appreciate that this problem is psychological and I need to get that kind of help.  However in the near term, as I said, there is this particular situation that's really important to me and that I want to try to get through it.

Any thoughts?  Also, are there any potential problems taking Viagra?  I've heard of side effects but I don't know much about them.  Does it elevate one's heart rate in a dangerous way?  How risky is it that one's erection stays after intercourse for a dangerously long period of time (this didn't happen when I tried it but I've now started worrying about this too, of course).  My health is generally fine (touch wood).

Thanks for reading.

[geoff19208]

Thank you for your response.  Does the fact that I am able to get an erection easily when I'm on my own suggest that this is primarily a psychological problem?  Also I don't smoke and drink so hopefully any aggravating factors are being kept to a minimum.

[S. Kaul, MD]

Hi there!

Erectile dysfunction can develop due to a variety of causes. Psychological stress, performance anxiety, depression, neurogenic disorders peyronie's disease, body image issues, medications, alcohol, smoking, drugs/medications, hormonal imbalance, radiation therapy, kidney failure, metabolic disorders, multiple sclerosis, hypertension, diabetes, prostatitis, urethritis etc. just to name a few. Anxiety and stress play an important role in the development of erectile dysfunction; and is the most common possible cause. At a primary level, I would suggest being a bit relaxed and working on the psychological factors. You could also see a psychotherapist/ behavioral therapist for the same. It might also be beneficial to get rid of factors like smoking/ alcohol/ drugs, if involved. Though medications such as Viagra can be used occasionally these are advisable under medical supervision with the lowest potential dose. If none of the changes seem to help, I would suggest considering an evaluation by a urologist for suggestion of an appropriate management plan.
Hope this helps.

Take care!