Erectile dysfunction is common. Thanks to commercials with Bob Dole peddling Viagra, ED is an acronym that has become a part of the American vernacular. ED is not just for old men or men who are unsophisticated with the ladies. My New York City -based practice is full of high powered men , men with beautiful wives/girlfriends and mostly men under the age of 40--all with malfunctioning penises. What is going on here? Pharmaceutical companies would love to have you believe that the condition is biologically-based and you should take meds. ( Test yourself: Do you get nocturnal/am erections? If yes, not due to a medical condition.) Although, certain medical conditions and medications do cause ED--check with your doc---in most cases, it is psychologically generated. Erectile dysfunction can be fleeting or it can be chronic. It may be due to situational factors (stress, fatigue, not attracted to partner, etc.), current psychological conflict (restentment towards wife, guilt, depression) or in rare cases, deep psychological conflict ( anger towards women, latent homosexuality, etc.) However, the single most common cause of ED, by far, is performance anxiety. The desire to please the woman has become so great that you experience pressure. Pressure to get hard and stay hard. You look for signs that she is pleased--reading her face and body for signs of satisfaction.You feel like a failure when she isn't responding. ( In reality, many women are simply lazy lovers who don't take responsiblity for their own pleasure.) You become a spectator and monitor your performance during intercourse. If you lose an erection, you worry about it happening again. This excessive focus on pleasing the woman has created a pressure to perform resulting in anxiety. The penis doesn't like anxiety.

When her orgasm has become the measure of your manhood ( setting men up for failure because 70%+ cannot have vaginal orgasms---clit stimulation only guys !), your ego has become involved. When sex becomes about your ego, you rob yourself of enjoyment. When your ego becomes involved, you rob yourself of the carefree nature of sex. You also forget about her. Hello! You forget about the connection. Sex becomes too goal-oriented. Get it up. Get it in. Get off. Women can sense when a man is using sex to validate himself and are turned off. Sexually liberated men (free of mental garbage) don't over-value her pleasure. They focus on their own sensations instead of hers. They focus on connection instead of using her body to masturbate.

• The solution: Don't be a spectator---get back in the game ! Re-direct your focus during sex. Keep your awareness on your pleasurable sensations and the enjoyment of her body. Get connected to her. Your erection is not the star of the show.
• side note: men tend to erroneously think that she is only satisfied if she has an orgasm. Although women enjoy orgasms, women are less orgasm-oriented than men. Women derive pleasure from penetration, connectedness and sensuality.

Dr. D