I see many male patients who feel like they are underperforming in the bedroom.

Anything limiting blood flow to the penis can cause impotence, now called erectile dysfunction. The most common conditions include cigarette smoking, diabetes, high blood pressure, alcoholism, drug abuse, normal aging, and depression.

Control blood pressure. Know your blood pressure. Most pharmacies have a self-inflating cuff. Check yours. BP should be under 140/90. If high, see a doctor for help.

Tobacco. Stopping smoking has innumerable benefits: better lung function , less cancer and helps blood flow throughout the body.

Drug Use. Some recreational drugs increase sexual arousal, but most all decrease sexual ability.

Exercise. A recent study of 178 healthy men showed those who reported exercise of 9 metabolic equivalents (like brisk walking for 30 minutes a day, 4 days per week) scored significantly higher on a sexual functioning survey. The mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men and 70 for highly active men.  This was statistically significant. The study controlled for all other factors and found that men reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction than sedentary men.

 Diabetes. Some cases of diabetes are preventable. Most adult onset diabetics are obese. Exercise and weight loss can ward off or stop diabetes. Aim for a body mass index (BMI) of 25 or less.

Evaluate medication use. Many commonly prescribed medications can interfere with male sexual function. Ask your doctor if any medications you are taking may worsen the problem and if a substitute medication could be started.

Some sexual therapy is free and should be started years BEFORE there is a problem. Stop tobacco and recreational drug use, excessive alcohol consumption and start a moderate exercise program.