For most men erections happen with little or no thought. And since the advent of the wonder drugs (Viagra and the like), even older men are having good success over their Willys’.  When a man comes to see me for erectile dysfunction it’s usually because he’s got one of the top five erection killers.

1. diabetes  2. high blood pressure medications (the cure is worse than what ails you) 3. smoking (especially controlled substances), and heavy drinking  4. high chloresterol  5. anti-depressants (those things are really, really sex killers).

Poor nutrition, unfit etc. certainly aid in the droopiness, but in 95% of the time it’s an obvious physical issue or obstruction. I can usually name the cause very quickly as it is rarely a difficulty "in your head".  Now I have a mysterious erectile problems that I can’t diagnois popping up in my office.  The first, a 24 year old guy who can very occasionally get an erection, for whom Viagra doesn’t work and who is extremely fit, on no medication and has a textbook- normal  sexual history, and all tests are negative.  At 24, he should be getting erections with a stiff breeze.  Can’t figure it out.  The second guy is 45, but fit, no medication, happily married, no contributing factors and is experiencing severe erectile dysfunction.  I hate to say it, but I’m at a loss. I have a hunch it may be related to toxins, but will keep you posted.  Any urologists with ideas are welcome to email me, but I will leave no stone unturned….Your friendly neighborhood sex therapist, saving the world one erection at a time.

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