Loss of libido and lack of interest in sexual activity are common symptoms of depression. ED is, in itself, a depressing experience for many men. Many men choose to accept a decline in sexual function as a natural consequence of aging. Because of shame or embarrassment, they do not discuss this problem with their health care provider. This is unfortunate because it is often possible to determine the cause(s) of sexual problems and many options are available to treat ED.

Performance anxiety Performance anxiety may develop in men who suddenly experience one or more erectile failures during intercourse. The focus of the sexual act shifts from a sensual experience to one filled with anxiety. During later attempts to have sex, the inability to acquire and maintain an erection becomes the focus of the sexual experience.

Sexual history The clinician will ask the patient personal questions about his sex life to help determine the cause of the condition. It is important that the patient answer the questions honestly and provide as much detail as possible.

The clinician will want to know if:

  • ED developed slowly or happened suddenly.
  • There are erections during the night or in the morning when he first wakes up.
  • There is similar ED with masturbation.
  • There are interpersonal problems with a spouse, girlfriend, or sexual partner.
  • There are any risk factors for impotence, such as a history of smoking, diabetes, obesity, high blood pressure, high cholesterol levels, alcohol or drug abuse, or depression.

Resuming sexual activity after a prolonged period of inactivity is similar to beginning a new exercise routine.

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