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Urology/Difficulty maintaining erection

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Question
Hi Doc, Thanks for the time.  I've recently noticed that I have been having difficulty maintaining an erection during sex.  I am a healthy 32 y/o male.  I exercise regularly and take no medications.  I recently stopped taking a pre-workout supplement, noxi-pro, that is an amino acid/nitric oxide solution.  I read that some men were having similar issues while taking it.  I have no problems becoming aroused at all.  When I'm alone there seems to be no difficulty either.  I may pleasure myself 2-4 times a week.  Can there be an issue there?  I have noticed that while flacid my stuff does not appear to be very "full" to best describe.  It has remained uncharacteristically soft while not aroused.  I don't know if I am having anxiety during sex or if there is another issue.  I know that during sex I tend to sweat a great deal.  I find myself fixating on that at times.  Also, it takes me a very long time to have an orgasm during sex.  The bottom line is that it's just not working like it used to.  Any insight or direction would help.  Thanks.

Answer
Nick:

I am not familiar with noxi-pro and so cannot comment on it.  Since you have no erectile problem when alone, your issues are likely to be more related to anxiety and nerves than physical.  You may want to discuss this with your primary care physician at your next checkup.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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