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Question:
Difficulty getting/maintaining erection , low sex drive
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Answer:
by Annette Owens: (05/20/2004)
Before I give you my final answer I would like to get a little more information from you. 1) Were you in a relationship when your sexual desire decreased and your erectile problems started? 2) Did anything else happen in your life at that time? 3) Are you in a relationship now? 4) If so, how does your partner react? 5) On a scale from 0 (penis flaccid) to 10 (penis fully erect) where are your erections A) during masturbation, B) when and if you are with a partner, C) in the mornings or when you wake up at night. 6) Did you have a doctor's check up, specifically checking blood pressure, blood sugar, testosterone and prolactin levels? 7) How would you describe your body weight? 8) Do you smoke? 9) Do you drink alcohol? 10) Did you start taking any of your supplements around the same time your problem started? 11) Are you taking any medications for any other reason?
If you can answer these questions for me, I can narrow down your problem and give you a more specific answer.
To answer your question about Viagra: As far as I know one does not develop tolerance to this drug. Viagra specifically acts to inhibit the chemical breakdown of an enzyme necessary for preserving increased blood flow during erections. If you want to know exact details about how Viagra works, you can check out my website www.CvilleWellness.com in the News section. Go to the archive to my book review on the book Sexual Health For Men by Richard Sparks and read the appendix.
Question 2: Hi, thanks for getting back to me. To answer your questions:
1) Were you in a relationship when your sexual desire decreased and your erectile problems started? Yes, same relationship for 7 years, nothing has changed between us, we do not argue etc, things are generally pretty good.
2) Did anything else happen in your life at that time? No, nothing what so ever. My life has been "business as usual"
3) Are you in a relationship now? Yes, same one.
4) If so, how does your partner react? She reacts fine. Does not nag, or pressure or anything like that. Very supportive and understanding.
5) On a scale from 0 (penis flaccid) to 10 (penis fully erect) where are your erections A) during masturbation, B) when and if you are with a
partner, C) in the mornings or when you wake up at night.
In all cases it's the same. Sometimes very hard (9) to sometimes not so hard (4), sometimes not at all (0). That's what is so UN-nerving about this.
Over all it does not get as hard as it USED to, say 12-18 months ago. It's hard to explain but the feel of it is not as firm. I would say that over all it DOES NOT get hard about 60% of the time. (Like when I want it to) It used to be that pretty much anytime I wanted to have sex, I could easily get a full erection. In the morning , usually wake with erection, but again it is not as hard as it used to , and during the night.. get erections but usually not as hard as it used to get.
6) Did you have a doctor's check up, specifically checking blood pressure, blood sugar, testosterone and prolactin levels?
Not all the above. Blood pressure-normal, blood sugar- normal.
Testosterone- did not check, prolactin-did not check.
7) How would you describe your body weight?
Not over weight. Physically in good shape. 6ft , 170lbs
8) Do you smoke? 9) Do you drink alcohol?
Don't smoke. Very little alcohol use
10) Did you start taking any of your supplements around the same time your problem started?
No except for the b vitamins (b-6,folate,b-12) did try stop taking them. No effect. Had always taken the other mentioned supplements.
11) Are you taking any medications for any other reason?
No other meds. Other than an occasional Viagra.
Like I stated in my initial email to you: I feel that I am too young to need Viagra, what do you think? I have heard that male performance declines as one ages. Is that what this
could be? Is 40 like a turning point? Are there any over the counter supplements I could try to increase my libido? I have read that Yohimbine is good but that the over the counter type is useless, one needs a prescription for it, is this true?
I would sincerely appreciate any input, information you could give to me
concerning this.
Final answer from Dr. Owens: Thank you for the additional information. I apologize for the delay in my answer, but it took a while for your latest message to get to me since we are still working on optimizing our new SexualHealth.com website.
Based on your additional information I recommend the following: Do have your Prolactin and Testosterone levels checked at your doctor's office. Sudden loss of libido and erectile potency can in rare cases be due to increased Prolactin levels and a decrease in Testosterone levels. This happens for instance if the pituitary gland secretes too much Prolactin, and it is usually easily treated with medication. So in your case, I think it is very important to determine those hormone levels. The fact that your erections seem less hard in all situations, including at night-time, points in the direction that it is not a psychological problem.
It is very important to realize that the normal aging process includes men needing more direct stimulation of the penis in order to become erect, and the time needed will often increase. But usually this does not happen as dramatically as in your case. I recommend the book The Sexual Male. Problems and Solutions by Milsten and Slowinsky (ISBN0-393-04740-7) for information on how sexual function changes during the normal aging process. 40 is not necessarily a turning point, but you should no longer have expectations of functioning as when you were 18.
Yohimbine is one of the oldest aphrodisiacs around and there is still much debate about whether it is effective for erectile problems or not. In 1989 the FDA stated that Yohimbine was not effective or safe for the treatment of sexual dysfunction. However, since so many positive studies (not submitted to the FDA for formal approval) on its effect exist many doctors prescribe Yohimbine for erectile difficulties. I would suggest asking your doctor about his or her opinion. And I would definitely choose the prescribed version. In order to increase sexual desire and potency Yohimbine primarily acts on certain receptors (called alpha-2) in the brain. However, the drug will also affect those alpha-2 and even other receptors in the rest of your body, and it may therefore cause numerous side effects such as indigestion, nausea, anxiety, nervousness, dizziness, headache, and more. But I do want to stress that Yohimbine does seem to improve sexual desire and erectile function in some men, and it may be worth a try under a doctor's supervision.
If your hormone levels are completely normal and your doctor cannot find any organic reasons for your erectile problems, I would suggest contacting a sex therapist, who may be able to help you further. You can locate a certified sex therapist by contacting the American Association of Sex Educators, Counselors, and Therapists (AASECT) at www.aasect.org.
Good luck, and best wishes to you and your partner!
Annette Owens, MD PhD
Reviewed by Sexual Health Editorial Team
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