ERECTILE DYSFUNTION: How It Happens, What Can Go Wrong, and Solutions   Dr. Paul Joannides is the author of Guide to Getting It On, now in its Tenth Edition. This is a well-known guide on sexuality which is used in college and medical school sex-ed courses in the U.S. and Canada. Please check out his comprehensive, informative website -- www.guidetogettingiton.com.      Dr. Paul and Dr. Diana began with the biological/medical aspects of erectile dysfunction (ED). Dr. Paul reports that 50% of men have ED at 50 years of age. Research shows that more than 60% of men who suffered a serious heart attack experience erection problems more than two years prior to their heart attack. So why is ED the canary in the coal mine for serious health problems?   ED can result from vascular issues (heart disease, high blood pressure, etc.) or the cause can be nerve-based (Parkinson’s disease, multiple sclerosis, etc.). Metabolic Syndrome is often present: being overweight, low levels of good cholesterol, high blood sugar.  Also, gum disease caused by no flossing increases the chances of experiencing ED by some 300%. Other life-style issues are involved including lack of exercise, poor diet, and drinking too much (causing “whiskey dick”). Also, if a man under 40 experiences ED, he is seven times more likely to have a heart attack when he is older.   For physical causes of ED, PDE-5 Inhibitors (Viagra, Cialis, etc.) help with the nitric oxide, relaxing the smooth muscle inside the penis, all in service of an erection. Another possible cause: too much tension held between the legs, in both men and women. Pelvic floor PTs often suggest that the patient stop doing Kegels because the muscles are too tight.   How about the psychological issues?  Quoting from Dr. Paul’s book: “Often, the biggest problem with ED isn’t the lack of erection. Rather, it’s a lack of playfulness and resourcefulness on the part of the man and woman when they are confronted with a hard-on that’s a no show.”   It takes most young men years, even decades, to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, rather just sticking it in. But few women appreciate how diminished men feel by ED. The couple needs to talk. Part of the problem is that men get less practice than women discussing their emotions, and when they do, they’re less skilled.   Dr. Diana discussed a case where the husband loses his erection during intercourse. The wife wondered if she did something wrong.  She asked, “What should I do when that happens?” Most erection problems are not caused by a partner doing something wrong but by feelings that the man has before or during sex. My advice: Don’t get pulled into a big drama about it. You want to respect your husband’s distress, of course, but you don’t have to agree that the sky is falling just because his penis does. They need to talk about how it feels, what she wants, what he wants, and what the options seem to be. The wife agreed this wasn’t much of a problem unless it’s made a problem by his turning away in frustration or anger.   Coping with age-related erection changes: forget quickies and spontaneous sex – schedule it; before making love, enjoy quality non-sexual time together: have fun; bathe or shower together beforehand; be patient with your penis. The latter is important and you can breathe deeply, kiss, cuddle, touch each other all over, savor novelty, enjoy vivid fantasies, and slow down with extended loveplay!   Do yourself a favor and get Dr. Paul Joannides’ book Guide to Getting It On.  It is a sensitive and playful guide; also funny, irreverent, intelligent and very honest … The very same qualities possessed by its author Paul Joannides! Furthermore, Dr. Diana knows him to be very kind and very sweet!