The PG-rated version of a common primary care topic

I spend a fair amount of time (almost everyday I'm in the office) reviewing issues concerning E.D.. It's still interesting that, despite all the information available, folks are so uninformed on many of the issues involved.

Here are a few things I try to review:

1. If you want to perform like Tarzan, you have to feel like the king of the jungle. Therefore, if you are not confident in your ability to perform, for whatever reason, there will often be dysfunction.

2. If everything works while you are alone, your plumbing and hydraulics are intact.

3. If you are not physically or emotionally attracted to your partner, your chance of success is less.

4. The heavily advertised, and commonly prescribed, oral medications do not work by themselves. In other words, you can't take one and then stare and wait for things to rise on their own.

5. If you are in a relationship that does not have respectful communication at its core your chance of E.D. is greater.

6. If you are in a relationship in which you are not yet comfortable to talk about E.D. with each other, you should wait until you are prior to attempting to be intimate. See #7.

7. If you are not able to tell your partner that you are using medical treatments to assist with E.D., it's probably not a strong enough relationship yet.

8. Four of the best things to do, if applicable (even better if you do it together): stop smoking, limit alcohol, lose weight and exercise. See #9.

9. Smoking, excessive alcohol use, being overweight and lack of exercise are probably more the cause of E.D. than the low dose of  blood pressure or anti-depressant medication you are taking.

10. Something as simple as a retention ring, available on the internet without a prescription, might be enough to allow you to perform for all to be happy. A vacuum pump is also a good nonpharmacologic option.

11. Testosterone can play a role, especially if you lack desire.

12. Remember that satisfaction, as a couple, does not always need to include "the act."

13. Success can almost always be achieved; it just depends on how much intervention one is willing to accept. Most clinics that guarantee success do so with the assistance of a needle and syringe.

I usually let folks know that I would prefer to do numbers 1-12 before considering number 13. Most, who are willing to participate in the discussion, agree.