Dear Dr. Joe: Why Don’t I Stand at Attention Anymore?

photo via flickr

Every few weeks, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality here on EMandLO.com. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

My erection isn’t at as high an angle as it once was (it’s a little droopier). Is there anything I can do to get that standing-at-attention look back?

— Flopsy

Dear Flopsy,

Okay, first things first. Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. That doesn’t sound exactly like your problem, but you may be on the way, so listen up.

Here’s how we get an erection. Excitement starts in our brains, causing arousal, and the brain sends a signal via the nervous system to the penile arteries. That signal says: open up and let the blood in. Blood flows in, and a chubby ensues.

A breakdown in this process at any point results in weakened erections and possibly erectile dysfunction. If the problem is in our heads (anxiety, lack of sexual interest, stress, etc.), then it is psychogenic. Brain can’t send the signal down to the arteries? Neurogenic. The signal arrives, but the arteries just don’t do their job? Well, that’s vasculogenic. Neurogenic and vasculogenic ED, frequently lumped together and labeled “organic” erectile dysfunction, imply that there is a physical problem, not just a psychological one.

Now, while it’s not “normal” to have erectile dysfunction, it certainly is very common – about 50% of men aged 40-70. And truthfully, a little decrease in your turgor with age is probably expected. We can’t be 18 forever! The most common etiology for erectile problems is vascular in origin, but in younger patients, I tend to see a lot of psychogenic erectile dysfunction as well.

So how can you get your stiffy back up to snuff? In essence, improving your erections involves reversing the abnormal process that is causing them. As you can imagine, that is not the easiest question to answer, given the variety of causes. For some, the problem fixes itself whereas others need to purchase peptides tadalafil for a little help. Here’s some general advice that may help. If the problem persists, head to a doctor.

Get enough sleep. Control stress. Get out of a bad relationship. Find a partner that you actually find attractive and care about. Stop smoking. Cut back on alcohol or quit altogether. Stop using recreational drugs. Try to minimize prescription medications if possible. Lose weight if necessary. Improve your diet. Exercise (both cardio and resistance).

Basically, improve your health. In fact, your erectile strength is a decent measure of your overall health, especially your cardiovascular health. Most of us have a pretty good idea about our unhealthy habits, so it’s up to us to have the discipline and motivation to change them.

Finally, please consider seeing a physician. ED is associated with obesity, diabetes, heart disease, high blood pressure, high cholesterol, and a myriad of other medical conditions. Get checked out — diagnosing problems early often finds them treatable and even curable. Your doctor might even offer some magic blue diamonds or some sildenafil to help see you through some tough times…

— Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.


  1. Point in order: Obesity isn’t a medical condition but a certain bodyweight.
    I can’t imagine that ED would be the first hint that someone is obese. Can you?

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