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The question: I'm embarrassed to say it, but I'm noticing that it's getting more difficult to maintain an erection. I'm interested in sex and feel desire but at 55, I can't maintain the same duration as I was able to as a younger man. Any suggestions for what I can do next to prevent this from getting worse?

The answer: Erectile dysfunction occurs when a man cannot get or sustain an erection that is firm enough for sexual intercourse. Every now and then, people can have difficulty maintaining an erection but if this is a long-standing concern, it can cause stress, relationship strain and affect self-confidence.

Although it may feel like you're facing this alone, erectile dysfunction is common and affects more men than we think. In fact, a recent study that involved 4000 Canadian men showed that about half of those between age 40 to 88 suffered from erectile dysfunction.

To understand what may be happening for you, it is important to know a few details about your health history that may put you at risk for erectile dysfunction. Erections occur when there is a flow of blood into the vessels in the penis. Anything that affects this flow or maintenance of blood to the penis can cause an issue with the strength of an erection.

These changes can be caused by medications that decrease blood pressure or conditions that may lead to a narrowing of the blood vessels such as high cholesterol, diabetes or smoking. For some men, erectile dysfunction is the first clue to an underlying condition such as diabetes or heart disease so it's important to get your doctor to run some simple blood tests.

Apart from the quality of blood flow, psychological issues can have a significant effect on erection as well. For some, if erectile dysfunction has been an issue, it can impact future interactions in the form of performance anxiety that can make the situation worse. For others, depression or anxiety and the medications that are used to treat these conditions can also alter libido and erection quality.

Treatment will depend upon what the underlying cause is.

So first, you should get checked out to ensure that diabetes, cholesterol or heart disease are not part of this issue. Your doctor can also look at your testosterone to ensure it is in the normal range for your age and if not, he/she can consider prescribing supplementation to bring your levels up. If you smoke, consider quitting as this will not only improve your chances of strengthening your erection but will protect your heart and body in the long run.

Your doctor may also be able to recommend medication that can increase the flow of blood to the penis. Common examples include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These are effective medications and work only when there is sexual stimulation. The potential side effects of these medications include headache, stomach upset and flushing of the face. Rarely, they can cause a prolonged erection that lasts more than four hours, which would require immediate attention. People who are on medications that treat angina (chest pain) or enlarged prostate should avoid this form of treatment as the combination can cause a sudden and dangerous drop in blood pressure.

If you've treated the potential underlying conditions related to erectile dysfunction and the medications don't quite work for you, there are other options that a urologist can suggest for you, such as prosthesis placement and vacuum suction devices that can enhance and maintain an erection.

While it can be anxiety provoking to discuss sexual health and specifically our most intimate experiences, the more we talk openly, the closer we can get to addressing your concern and finding ways to help.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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