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Question:
I am a 52 year old man in a monogomous, loving relationship with a younger woman. I have for a long time suffered the embarrassment of erectile failure during intercourse. I am healthy, have little stress other than the fear this might happen again... and of course it does. On the couple of occasions I've used Viagra, the results have been very satisfying, but I don't want to develop a dependancy. What can you suggest might help me long term ??
SR 
Answer:
Thank you for your inquiry. Rather than address the longer term, in the short term it can be helpful to see your doctor as there are a number of medical conditions (whose frequency increases with age) which can result in this problem; there are also a number of medications taken for relatively common conditions which can have the same effect. That said, the statistical likelihood of a specific cause is more commonly behavioral than medical; one failure causes a large amount of worry that it will happen again; a second failure 'proves' it will, third and subsequent failures are all self-reinforcing. Learned behavior responses can be unlearned, but if this should be the primary cause of the problem, both its diagnosis and subsequent treatment need to be done with your physician. Generalizations about likely causes are only useful when talking about groups of patients and for something as important as this you really need a one-to-one consultation rather than a series of possibilities. It should be noted in passing that Viagra dependency is not generally a physical one; rather, it appears that satisfied users find the quality of sex without Viagra less appealing and therefore tend not to want to do without it. This is the reason why many shy away from its routine use; however, its use in cases of erectile dysfunction is said not to have this disadvantage (as without Viagra in this case there is no penetrative sex at all) and there is no 'drug-induced addiction' associated with its use in this context. Hope this helps.
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