You Gotta Get Up to Get Down

Ah yes. The infamous limp pecker. A condition so universal it deserves its own support group—and yet most men would rather wrestle an alligator than talk about it.

Let’s get one thing straight: almost everyone experiences performance issues at some point. Nerves. Booze. Stress. Physical health. Mental health. A partner who suddenly feels more like a roommate with a pulse. The good news? Most sexual performance problems are reversible—and many are completely avoidable.

Take erectile dysfunction (ED). The usual physical suspects are boring but important: circulation and blood pressure. Heart disease, clogged arteries, high cholesterol, hypertension—anything that messes with blood flow is going to mess with your erection. Diabetes damages nerves and blood vessels. Smoking kills erections just as efficiently as it kills lungs. Some medications are absolute boner assassins.

Then there are the less clinical contributors: kids, money, work stress, existential dread, or the person warming your side of the bed. Yes, sometimes the partner is the problem. That’s not heresy—it’s reality.

And here’s where things get uncomfortable: sometimes a man simply isn’t interested in sex anymore. No trauma. No diagnosis. No secret disease. He just doesn’t care. This happens far more often than anyone admits, because in our testosterone-soaked culture, a “real man” is apparently supposed to be horny until death. But if it’s not a problem for him, then clinically speaking, it isn’t a problem—even if it’s a problem for the partner. That’s another blog, but it matters.

Let’s clear up a major myth: If you can’t get it up with Bill or Susan but have zero trouble with porn, fantasy, or that one mental image you keep tucked away, you probably don’t have ED. You have a context problem, not a penis problem.

Tumescence—aka swelling in response to arousal—is the keyword here. Morning wood? That’s your body saying, “Mechanics are fine, buddy.” If erections happen during sleep, chances are the issue is psychological, relational, or situational—not physical.

Before you panic and start popping sildenafil like Tic Tacs, pause. PDE5 inhibitors (Viagra, Cialis, etc.) are vasodilators. They widen blood vessels in the penis. They do not magically summon an erection out of thin air. No stimulation? No hard-on. High-fat meal beforehand? Congrats—you’ve just sabotaged the pill.

And let’s talk side effects. Indigestion, dizziness, headaches, fatigue. I’ve taken sildenafil (purely in the name of science, of course). Yes, it worked. However, the hours of raging indigestion were not worth the novelty.

Now for a little mind-bender. Some studies (MansMatters, among others) suggest fluoride in toothpaste may suppress nitric oxide synthesis—a key player in erections. Where is nitric oxide commonly produced? The mouth. Where does toothpaste go? The mouth.Hmm.

I haven’t used toothpaste in years. My teeth are gorgeous. Draw your own conclusions.

Here’s the bigger issue: association. Not addiction—association. If a man starts believing he needs a pill to perform, that belief alone can become the problem. It’s easier to swallow a tablet than to confront stress, resentment, boredom, relationship rot, or unresolved psychological junk. Pills don’t fix meaning.

That said—pay attention to red flags. If everything in your life is solid and you still can’t get an erection under ideal circumstances, that’s your body waving a big red banner. Go see a doctor. Erectile issues can be early warning signs of serious medical conditions. Ignore that at your own peril.

Now listen closely, because this matters: embarrassment is deadly. Your healthcare provider has seen it all. All of it. Be honest. Be direct. If you have to bend over or whip it out—do it. It beats dying quietly of something preventable.

And if your doctor lectures you, shames you, or plays moral police? Fire them. Immediately. I have zero tolerance for clinicians who judge patients—especially the hypocrites who publicly moralize about sexual behavior while privately behaving worse. STIs don’t care whether sex happens in a back alley, a bar bathroom, or an ivory tower. Risk is risk.

If you’re struggling with erections, desire, ejaculation issues, or notice lumps, bumps, bruises, or anything that makes you pause—see a professional. If it feels psychological, see a sex therapist. If you don’t have one, start with your primary care doctor. And while we’re here: a Psychiatric Nurse Practitioner is not a therapist. They prescribe. They don’t do depth work. Don’t confuse the two.

I’m consistently amazed by people who smoke, eat like garbage, live stressed-out lives, take a pharmacy’s worth of pills, have a belly the size of a small Country—and then tell me they have no idea why their dick doesn’t work. Is it denial? Lack of insight? Magical thinking? Pick one.

Bottom line: healthy erections come from healthy lives. Eat better. Move your body. Reduce stress. Address the underlying issues rather than medicating the symptoms. Your penis is not broken—it’s communicating.

You just have to be willing to listen.

Dr. B. K. Wise

The Master Counselor