Do you have any help for a man who has suddenly found himself struggling with erectile dysfunction? My wife and I are in our mid-fifties, and up until a year ago we had a healthy and vigorous sex life. That was when, almost overnight, I began having issues. I'm embarrassed and frustrated to the point that I'm afraid to initiate love-making with my wife. She's been very kind and understanding through all of this, but my inability to pleasure her like I once did is very upsetting to me. I'm afraid and don't know what to do.
First of all, relax and take a deep breath. This is a very common problem, as all of the television commercials you may have seen for Cialis and Viagra will attest. About five percent of men in their forties experience some difficulty with erectile dysfunction (ED). The number is closer to fifteen to twenty-five percent in men over sixty-five. You can take some small comfort, then, in knowing that you're not alone. And the good news is that there's a great deal that can be done to help you with this problem.
Having said this, we should hasten to add that your embarrassment is completely understandable. Sexuality is such a private and personal thing that most of us are reticent to discuss it with it anyone, including our spouses. While the thought of broaching the subject with anyone, whether a friend or a professional, may feel particularly daunting, the first step toward the help you're seeking will be to overcome this emotional barrier and make an appointment with your doctor. Most problems with sexual functioning can be handled by a primary care physician, such as a family practitioner or an internist. In some cases he or she may refer you to a urologist, who specializes in problems of the male reproductive system.
The first order of business with your physician will be to identify what might be the cause(s) of your erectile dysfunction. A variety of factors can contribute to this problem, and more than one may be present in the same individual. Up to 80 percent of cases are physical in origin, involving blood flow, hormonal factors, nerve function, or even medications you might be taking. A smaller percentage are psychological in origin (including situations where sexual performance is affected by circumstances and surroundings), and a number of cases involve both physical and psychological factors. Often a failure to obtain a satisfactory erection, for whatever reason, can further provoke ED, and even a reluctance to have sex, as a result of anxiety about future sexual performance.
Of all of the reasons for erectile dysfunction, the most common involves blood flow - or more specifically, a malfunction of the cells that form the inner lining of blood vessels. There is often an important link between ED and underlying atherosclerosis, the diffuse disease of blood vessels that can lead to a heart attack or stroke. The common risk factors for atherosclerosis, including hypertension (high blood pressure), elevated cholesterol levels, diabetes, and cigarette smoking, are themselves associated with erection problems, and ED may be the first indication that a man has this common condition. You should not be surprised or alarmed, then, if your discussion of ED leads to a wider assessment of your overall health.
A low level of testosterone affects approximately 2 to 4 million men in the United States and becomes more common with advanced age. When associated with specific symptoms, this condition is called hypogonadism. Not surprisingly, low testosterone may be associated with sexual problems such as decreased sex drive, erectile dysfunction, and difficulty achieving an orgasm. But more generalized symptoms may occur as well, including decreased overall energy, depression, a reduction in muscle mass and strength, and anemia (low red blood cell count). When appropriately treated with supplemental testosterone, men with hypogonadism may experience improvements in many of these symptoms.
In addition, many types of medications can cause not only erectile dysfunction but also decreased sex drive and other sexual problems as well. These include:
- Certain types of antihypertensive (blood pressure-lowering) medications, especially beta-blockers (such as propranolol and metoprolol), alpha-blockers (such as prazosin and terazosin), and diuretics such as hydrochlorothiazide and spironolactone.
- Antidepressant medications, many of which are associated with both loss of sexual desire and erectile dysfunction. This can create a dilemma when a drug significantly improves mood but interferes with sexual function. The widely used selectiveserotonin reuptake inhibitors(SSRIs) as well as the older tricyclic antidepressants commonly cause this problem.
- Some nonprescription antihistamines and decongestants (used to relieve symptoms of colds and allergies), which may cause both erection and ejaculation problems.
Two other activities, one healthy and one definitely not, can also contribute to ED:
- More than three hours per week riding a bicycle, especially on a narrow saddle seat, can compress arteries and nerves that supply the penis, leading to problems obtaining and maintaining an erection. Replacing at least some cycling hours with another form of exercise, sitting upright on the bicycle, and using a "no-nose" seat that distributes pressure more widely over the buttock region, may help resolve this. 
- There is a growing body of evidence that repeatedly experiencing orgasm through masturbating to pornography can interfere with real live sexual intimacy. Aside from the relational chaos that exposure to pornography brings into a marriage, the same neurochemical changes in the brain that can turn this behavior into a true addiction can also desensitize a man's response to an actual sexual encounter. 
The popular drugs sildenafil ( Viagra), vardenafil ( Levitra) and tadalafil ( Cialis) have drastically improved the outlook for men with this problem and have proven quite effective at improving erectile function, whether of organic or psychogenic origin. Aggressive marketing of these drugs to the general public, including invitations for men to ask for free samples from their physician, has had the positive response of starting much-needed discussions about this subject in the doctor's office. Unfortunately, these conversations often begin just as a visit for some other problem is wrapping up. The doctor is about to leave the exam room at the end of a visit when the patient suddenly asks, "By the way, Doc, could I get a sample of Viagra?" Medical professionals refer to this as the "doorknob sign" that indicates a problem with erectile dysfunction. Here's an important tip: Primary-care physicians and urologists are usually more than willing to discuss this subject, but it involves more than simply handing out a sample. The doctor will need to gather some basic information about your experience with this problem, including its history, other medical issues (especially cardiovascular risk factors), and current medications.
If after examining you and conducting the proper tests your doctor decides that your difficulty may not be entirely physiological in origin, the next step is to take a closer look at emotional, relational, and psychological factors. Remember, the brain is the most important sexual organ in the body. It's difficult to make love to someone with whom you are angry or of whom you are afraid. Issues of shame, safety, power inequities, performance pressures, unforgiveness, and many other factors can create chronic sexual problems in a marriage. If these issues exist but are not addressed, it's possible to end up treating symptoms without getting to the root of your problems.
It's important to note that even when ED is traceable to physical causes, worry can definitely make matters worse. Fear, embarrassment, and performance-related anxiety are never conducive to achieving an erection. Given your spouse is understanding, we'd recommend that you talk with her at length about this aspect of the problem. It would also be a good idea to engage the assistance of a trained and qualified Christian counselor.
An excellent way to counter fear and anxiety and open up the channels of sex-related communication with your spouse is to acquire a good book on the topic - for example, Restoring the Pleasure, by Clifford and Joyce Penner - and go through it together. Take turns reading aloud to one another. When you get to the end of a chapter, stop and discuss what you've read. While this kind of dialogue may feel awkward at first, the further you go with these sessions, the easier it will become to talk openly about sexual subjects in general and the state of your sexual union in particular.
Important: If you are dealing with an addiction to pornography, you will need to take a more focused and intensive approach to this problem. A few conversations with your wife (which are not likely to be comfortable for either of you) will not be enough to manage it. You will need counseling, relentless accountability, prayer, hard work and time to break the chains of this addiction. This often involves intensive therapy for the couple, as well as additional counseling and assistance for the addicted partner. One excellent resource for men is a workshop called Gateway to Freedom .
Focus on the Family has a staff of trained family therapists who are available to speak with you over the phone. They can refer you to reputable and qualified marriage and family counselors working in your area. They'd also be more than happy to discuss your concerns with you person-to-person. If you'd like to talk with one of them, you can reach them for a free consultation at this number.
"Biking and Erectile Dysfunction: A Real Risk?" by Tom Valeo. http://www.webmd.com/men/features/biking-and-erectile-dysfunction-a-real-risk . (Accessed 8-17-15)
"Does Porn Contribute to ED? Growing evidence suggests that too much porn can diminish sexual performance."
Post published by Tyger Latham Psy.D. on May 03, 2012 in Therapy Matters.https://www.psychologytoday.com/blog/therapy-matters/201205/does-porn-contribute-ed (Accessed 8-17-15)
Restoring the Pleasure (book)
Overcoming Sexual Brokenness (resource list)
American Urological Association
Be Broken Ministries - Serves men (married, single, or divorced) and couples affected by pornography and other sexual struggles and strongholds.
Pure Intimacy - a Focus on the Family Web site offering articles and resources that assist both men and women in the pursuit of God-honoring sexual purity, and recovery and redemption from sexual brokenness.
Gateway to Freedom - A 3-day workshop for men seeking to overcome pornography and any other sexual struggles or strongholds