Why do I have erection problems despite Sildenafil use?

Question

Hi doctor,

A 61-year-old male is in very good to excellent health, with a blood pressure of 130/80 mm Hg and 24 % body fat. I am physically active and on these medications, such as Allopurinol (gout) and Doxycycline (adult acne). For the past three years, with 100 mg Sildenafil, I had almost immediate and very strong first erections, strong climax, a 30-minute refractory period, strong second erection, and super strong second climax, though reaching the second climax could take much longer than the first (which was actually good).

About three weeks ago, I suddenly stopped being able to achieve the second erection. First erection is unchanged. Nothing has changed in my relationship with my partner. I continue to find her very attractive, and she is very enthusiastic about sex. I understand the human body ages in bursts, not linearly, but even so, this feels awfully sudden.

1. What are the possible causes?

2. What do you see as the most likely cause?

3. Are there ways to go back to my old performance?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

From what you describe, your overall health profile is excellent for 61, and the sudden change can understandably feel worrying. First, regarding Sildenafil, it is primarily an erectile dysfunction medication, and 100 mg is the higher end of the dosing range. Usually, we start at 25 mg, then increase to 50 mg, and only if needed to 100 mg. While Sildenafil can indirectly help prolong intercourse by improving erection quality and confidence, it is not a medication for ejaculation control.

For premature ejaculation, Dapoxetine 30 mg is more commonly used, and in selected cases, a combination of Dapoxetine with Sildenafil may be prescribed under medical supervision. Now, about the second erection, a longer refractory period with age is completely normal. In many men over 60, the second erection may take several hours, sometimes even six to 24 hours, and this is physiologically common.

Being able to consistently achieve a strong second erection within 30 minutes at 61 is actually above average. The body can sometimes be “pushed,” but that does not always reflect normal physiology. A sudden increase in refractory period can be due to subtle stress, performance pressure, mild anxiety (even subconscious), changes in anticipation, or simply age-related shifts in neurovascular response. Sometimes expectations themselves create performance stress.

Even if the relationship is strong and attraction is intact, internal pressure to “repeat peak performance” can affect the second erection. Most likely cause in your case, age-related refractory period change combined with psychological expectation or performance pressure, especially since the first erection remains strong and unchanged.

If there were a vascular or hormonal issue, we would expect the first erection quality to decline as well.

To improve performance:

Optimize testosterone naturally through resistance training, adequate sleep, healthy fats, and maintaining 15 to 18 % body fat if achievable safely.
Add mental stimulation, new forms of intimacy, pacing, longer foreplay, or varied techniques.
Reduce performance pressure, focus less on “second climax” as a goal and more on shared pleasure. Ensure good hydration and avoid alcohol before sex.
If concerned, you may check morning total testosterone, fasting glucose, lipid profile, and thyroid, just to rule out metabolic contributors.

I hope this information will help you.

Thank you.