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Performance Anxiety and Impotence

Dear Dr. Dave and Dr. Dee,

I'm 18 years old. I've never had a problem with impotence, never had trouble achieving an erection. But about 2 weeks ago, before sex with my girlfriend, it was very very difficult to get an erection. Ever since, that's the only thing on my mind. I find myself constantly worrying about impotence. When I'm intimate I find myself doing nothing but worrying. I do get erections, it just takes a while. Do you have any advice or ways I can get this off my mind? I've heard that a lot of impotence cases are mental.


How do I get over this?

Dear How do I get over this,

It isn't unusual for a healthy 18-year-old with otherwise normal erectile function to develop temporary erectile dysfunction. This is usually due to performance anxiety. This is not impotence, which is a chronic condition.

Impotence is most often linked to blood flow problems, usually due to blocked arteries and/or leaking veins. Blocked arteries and vein leakage problems are complex, but in general result from a blockage of arteries through which blood flows into the penis, or a loss of compliance of the erectile tissue inside the penis and the veins through which the blood leaves the penis. These problems, which are often related to atherosclerosis (hardening of the arteries), are seldom seen in otherwise healthy young men, although they can occur at an early age in individuals with diabetes or a number of other chronic medical conditions.

Some impotence is due to malfunction of nerves to the penis, as seen in people with spinal cord injuries. Sometimes the cause of impotence is purely psychological, but often psychological problems are a reaction to, rather than a cause of impotence. Smoking is a major risk factor for developing impotence, which is yet another reason for folks to quit. Alcohol impairs erectile function.

It may be useful to step back and take a mental inventory, looking for causes of anxiety. We often feel that we're experiencing little or no stress, but closer examination sometimes reveals quite the opposite. Stressors can arise from family discord, employment problems, financial issues, school stressors, death of a friend or loved one, divorce in the immediate or extended family, moving to a new residence, and so on. Assess the circumstances under which you are attempting to have intercourse, and take a look at your true feelings about your significant other.

If problems continue, then a medical checkup with your primary physician is necessary. If that turns out OK, your physician can offer you helpful counseling.