Patient: Hi Dr. I am a 23 year old man and I have a few questions regarding some erection problems I have been having. For several years now, off and on, I have had problems achieving or maintaining an erection for intercourse due to performance anxiety. There are times when I don’t have any symptoms at all for months or even longer and I have great sex, but once I am unable to perform once or twice it really messes with my head. I have been diagnosed and treated for anxiety disorders since I was 14 years old and all my symptoms (obsessive worry over quality of sex, adequetcy, etc.) seem to be classic for having a problem due to my anxiety disorder. Obviously, I’m going through a bout with my sexual performance anxiety currently and I am wondering about the best course of action to correct it and have a few questions. 1)- I have a prescription for ativan (0.5 MG) that I take as needed which is rarely if ever. I am curious if taking one of these before anticipated sexual encounters with my girlfriend would help or hurt my problem (since it would calm me down a bit but I have heard benzo’s can interrupt sexual function) 2)- I started taking a mens multivitamin, b complex and vitamin c to try and make sure my essential body functions are working right to optimize my chances of a good sexual experience. However, I’m curious if a supplement like horny goat weed would be more effective even though it seems as though my problem is more psychological than physical (at least that is what it seems to me) Any other advice you could give me would be a great help and greatly appreciated. I just started a new relationship with a great girl and I want everything to go well, and I’m hoping to get back on the right track as soon as possible. Thanks so much.
Doctor: In my opinion, your problem seems to be psycological and best option would be to go for a psychotherapy, cognitive behav iour therapy (CBT) along with medication therapy like buspirone that has no sexual side effects as with benzodiazapines. A healthy diet, sound sleep and avoidance of smoking or alcohol (if thats the case) may improve your physical as well as mental health. Meditation and yoga would help reduce your stress and anxiety, and thereby improve your performance.