Few things are more difficult for a man than admitting he is having an erection problem. Even confessing it to a physician is so embarrassing that men put it off for as long as they can, sometimes until it is too late to correct the situation easily.

Most women have great difficulty in understanding the depths of humiliation a man feels when, in the midst of passionate foreplay, his penis does not get erect. They also have great difficulty understanding the even more humiliating situation when an erect penis suddenly and without warning goes limp.

Erection Problems Happen to Everyone

When a woman’s genitalia do not lubricate, she can reach for the K-Y Jelly or her partner can use saliva. Even if she is not terribly aroused, a woman can proceed with intercourse. If she wants to, she can always pretend to be passionate.

A man without an erection has no such fallback position. With his penis drooping like a flag on a windless day, he is stripped bare of all pretenses. No artifice can compensate. This is a nightmare worse than dropping a touchdown pass in the end zone or striking out with the bases loaded.

Even if it happens just once, the event can be devastating. Very few men are able to shrug it off. When it happens more than once, the shake-up to self-esteem is high on a man’s Richter scale. Most men fail to realize that they should shrug it off. This happens from time to time to every man.

How a Doctor Can Help

When a male patient comes into my office and reluctantly admits that he is having problems, the first thing I do is try to make him feel comfortable and safe. He can then speak openly and honestly about his situation.

Usually, the conversation starts with some equivalent of: “Doc, my friend has this problem.”

I quickly try to earn his trust and confidence by letting him know that I understand it is his predicament, and that no matter what the details of the problem may be, we will straighten everything out.

Once I establish rapport, I take a medical history. The first thing I want to know is whether his problem with erections is of recent origin or if it has been going on for a long time.  I then ask if the onset of the problem was sudden or if it was gradual.  I ask a series of questions about his personal life, general lifestyle, and emotional state of mind. I follow an algorithm (a preset course of medical questions) in which the patient’s answers guide each subsequent question. This leads to an accurate diagnosis.

You would be surprised how many men come to me in a complete penis panic, only to find out that their problem is not medical, but circumstantial. These circumstances include a marriage in jeopardy, aggravation over a business predicament, or just plain mental and physical fatigue.

If my analysis of the problem to this point has not revealed any obvious situational cause, my line of inquiry turns to medical factors. When the penis fails to perform properly, and when psychological factors are ruled out, the diagnosis falls into the clinical category of organic impotence.

Even though only a small number of the men who come to me fall into this category, my first responsibility is to search for a possible medical cause of the problem. Before embarking on a sophisticated medical evaluation, I have to be convinced that the patient is, in fact, physically incapable of having an erection. This is often accomplished with one question.

Take the case of a fifty-year-old executive who came to me with a minor irritation on his scrotal skin (the skin covering the testicles). I prescribed a topical ointment. I then listened as this aggressive, no-nonsense mover and shaker gazed at the floor and sheepishly told me the real reason for his visit to my office: “Doc, I just cannot get it up lately.”

He said he felt fine otherwise and was not under any exceptional degree of stress. At that moment, my secretary buzzed to tell me that the lab assistant had stopped by to pick up a blood sample. Knowing that this assistant was a beautiful young woman (a frequent occurrence in Los Angeles, where unemployed actresses almost outnumber unemployed urologists), I seized the opportunity to use a visual aid to solve this diagnostic problem.

When the assistant entered the exam area, we exchanged pleasantries. I handed her the sample and she left. I watched as my patient eyed her shapely figure as it swayed out the door.

“If she came on to you,” I asked, “do you think you would have any problem rising to the occasion?”

“Are you kidding, Doc?” said the patient. “When do we start?”

The patient’s “medical” problem was solved because it never really existed! His problem was not the result of an anatomic malfunction of his organ.  His penis weakness was the result of problems within his marital bedroom.

A remark like the one he made does not constitute scientific proof, but in this patient’s case, there was other evidence that the problem was not physical. He confessed to having had a recent dalliance with a woman he met on a business trip. During the affair, he performed adequately. From that fact alone, I was certain that the patient was not physically impaired. Therefore, I counseled the patient along psychological lines. I suggested that he and his wife see a marriage counselor.

For most patients, the question of whether a penis problem is physical or mental cannot be settled in an interview. I have to use reliable, objective criteria.  I have a method that is foolproof, but that’s another topic for another blog post.

Written by Dr. Dudley S. Danoff, M.D., F.A.C.S.
Author of Penis Power: The Ultimate Guide To Male Sexual Health
All Rights Reserved (c) 2011 Dudley S. Danoff