William E. Jones, MD

The term "impotence" sounds awful, doesn't it? It seems to connote some sort of awful, inevitable thing that marks the end of a man's life as a lover. Men are horrified at the prospect and are reluctant to even say the word "impotence" (even to their doctor) except in jest. The medical term for impotence is "Erectile Dysfunction" (ED) which sounds much less ominous; so I'll use that from now on.

From the time we were young teenagers we men have been programmed to connect a major part of our masculine identity (for some men even their sense of self-worth) to our erect penis. When our penis "let's us down" for the first time, usually at a critical moment, that totally rattles a man's confidence; and fear of failing the next time begins to gnaw at him subconsciously. Erections don't begin from between the legs, they begin from between the ears; and if a man starts into lovemaking worried that he might fail (again!), the odds are that he will fail to develop (or maintain) a satisfactory erection.

This typically becomes a vicious cycle: increasing fear of failure resulting in more and more failures until the man stops even trying. It's less emotionally traumatic for a man to just give his wife a peck on the cheek and then roll over with his back to her, pretending to be asleep, than it is for him to try to make love to her and then fail... yet again.

His wife, of course, usually doesn't understand what's going on with him. Often the wife will lie there in bed, wide awake, staring at the ceiling, blaming herself, thinking, "What's wrong with me? He used to want me all the time, and now he doesn't seem to find me sexy any more. Am I getting older and becoming unattractive to him? Is he having an affair with someone else?"

Some wives, with the best of intentions, will start doing all sorts of sexy, fun things to try to "rekindle" the passion (a romantic candlelight dinner at home with the kids away for the night, sexy lingerie, perfume, etc.) Unfortunately, if the couple is not communicating clearly about the man's ED, this "seduction" puts all sorts of added pressure on him to perform when he's already convinced himself subconsciously that he can't. When he doesn't respond to his wife's attempted seduction as she had hoped he would, both partners become even more frustrated and confused.

There are many factors that may contribute to Erectile Dysfunction, but the underlying cause in most men is simply age. Other factors (certain medications, stress, marital difficulties, just to name a few) then amplify the problem.

The good news is that the new treatments for ED work very well in most men, but the most important thing a couple can do is communicate clearly about ED. If you're working on this thing together, trying to overcome it as a team, it helps to take the pressure off the husband; so his odds of success, even without medical help, will be improved significantly.

If ED is becoming a problem in your relationship, I encourage you to discuss it with me at your next visit. Remember, you're not alone - ED is something I hear about all the time (once a man works up the courage to mention it). Everyone knows about Viagra which works very well and lasts for about four hours. Many men now prefer a new pill called Cialis that works like Viagra but lasts 36 hours, an entire weekend. There are also a variety of other treatments now available for ED; so let's talk about your problem and get it corrected.