Q. I’m a 38-year-old man. I have undergone 15 surgeries since 1991, and I was doing fine until recently. I had a knee replacement and two discs removed, and I’ve been taking various medications. My problem is that I have the sex drive, but I’m lacking in the staying power. The most I can last is only two minutes, a far cry from my better days. My girlfriend of five years left me over this. I’m wondering what if anything can help me feel “manly” again. I’ve tried vitamins, DHEA, etc. to no avail.

A. Because you have had back surgery and are taking medications, I would recommend you return to your doctor for evaluation of the cause of your impotence. Inability to get or maintain an erection can be due to a number of causes. Many medications — including blood pressure medications, sedatives, tranquilizers and stimulants — can cause impotence. Your doctor will know if any medication you are taking has this side effect and may be able to change your medication to something different.

Another possible cause of impotence is damage to the spinal nerves. Since you have a history of back surgery, this is a possibility. A neurological examination by your doctor will be able to determine if there is any problem with the nervous system. Occasionally, endocrine disorders such as diabetes, low thyroid and low pituitary hormones cause impotence. Blood tests can rule out these disorders. Alcohol consumption and cigarette smoking can also cause impotence. So, if you smoke, stop. If you drink alcohol, stop or limit your intake to one drink a day.

The most common cause of impotence is decreased blood flow in the penis due to atherosclerosis or blockage of the arteries. A healthy diet with lots of fresh fruits and vegetables, whole grains and lean meats and fish along with a good vitamin-mineral supplement will help lower cholesterol levels and prevent atherosclerosis. Regular exercise is also important. The new drug Viagra is useful to increase penile blood flow. It works immediately, but it carries a risk of heart attack, especially in men who have atherosclerosis. Ginkgo is an herb that has been shown to be effective in increasing blood flow to the penis; unlike Viagra, it takes six to eight weeks to have an effect, but it will also be beneficial if you have blockage in the arteries of the heart.

Finally, you might also want to see a counselor. The issues with your girlfriend over this may also be having an effect on your erections. While psychological problems are rarely the primary cause of impotence, just having difficulty with erections may add a psychological component to the problem.

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