Sex: Men: Troubleshoot Your Sex Life (cont.)

"I wish I could buy billboards all around the United States that said 'With every puff (of tobacco), your penis suffers,'" Castleman says.

Step 3: Check Your Medications

Erectile dysfunction can also be an unwelcome side effect of many commonly prescribed drugs, as well as some over-the-counter agents and illegal substances, according to researchers.

Talk to your doctor about this possible side effect if you're taking drugs to treat:

Your doctor may advise you to switch to another drug. Or your doctor may suggest taking the drug at a particular time of night when it's less likely to interfere with your sexual vitality.

Substances such as alcohol, anabolic steroids, heroin, and marijuana can also cause impotence, experts say.

Step 4: Consider Preventive Treatment

There are several treatments for erectile dysfunction. Most of you know about the drug treatments: Cialis, Levitra, and Viagra. But those drugs aren't for everyone.

Other treatments include therapy, penile injections of medications and surgery. Each type of treatment has its own advantages and disadvantages. Talk to your doctor to determine the best treatment for you.

Step 5: Set New Expectations

It may be no surprise to women who are reading this, but men who are used to being ruled by their loins rather than their heads need to understand that "sex doesn't just happen in your penis: Lovemaking is a whole-body experience," Castleman says.

"When Michael Jordan takes a jump shot, does he use just his wrist? No. He's using his whole body; everything's got to work together. The way the human body is constructed neurologically is that sexual excitement, sexual arousal is a whole-body experience, and if you focus too much on one part of your body it doesn't work right."

He says that men should have a realistic understanding that after about age 50, erections are slower to rise, and they come and go during love-making.

"After the mid-40s, many men have erections that kind of wax and wane during lovemaking," Castleman says. "It's perfectly normal, and what men need to do is have a little chat with the women in their life and say, 'Look, this is what's happening to me now, and I need more stimulation from you.'"

Originally published May 20, 2003.

Medically updated Oct. 18, 2004.

SOURCES: Irwin Goldstein, MD, professor of urology and gynecology, Boston University School of Medicine. Michael Castleman, sex educator and author, San Francisco. American Family Physician, Sept. 15, 1999. The Primary Care Management of Erectile Dysfunction. Department of Veterans Affairs Veterans Health Administration Publication No. 99-0014, June 1999.

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