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Erection problems: psychological or physical?
QUESTION:
Hi I'm in my 30s and am having trouble getting erections during sex and sometimes with masturbation. I think it is stress related. I went to a urologist who prescribed me Cialis. It definitely gives me better erections for about 4 days. However even with the drugs I lose my erection when I'm with a lady but not with masturbation. I think it is a combination of performance anxiety and fatigue as I rarely get more than 5 hours a night sleep. I don't wake up with morning erections very often. I'm in pretty good shape and have no known heart disease or Diabetes. Do you think this is more likely to be psychological or organic? I'm planning to go back to my urologist and possibly sex therapy. Is sex therapy effective? Thank you.

ANSWER:
Thanks for your question. Yes, sex therapy is often effective for men who have concerns about erectile functioning. In fact, sex therapy plus medication for erections (such as Cialis) is often more effective than just medication alone. Good for you for exploring a range of options including making sure that you are in good health by checking in again with a urologist or other healthcare provider. On one hand, when a man has a trouble with erections during partner sex but not masturbation, it may seem like the issue is psychological, such as related to performance anxiety (concerns about pleasing your partner or being "good" in bed). On the other hand, since you rarely wake up with morning erections, one might wonder if there is something physical going on - which may, actually, be the lack of sleep and overall stress that you may be experiencing. As such, meeting with a sex therapist (you can find one near you through the American Association of Sex Educators, Counselors and Therapists) and a healthcare provider seem like good next steps to consider.

-Debby Herbenick
http://www.kinseyconfidential.org
 
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