At the clinic, the first thing a specialist will attempt to determine is the primary cause of your problem. The most basic question is, Is it mainly physical, or is it mainly psychological? (Again, these things are often devilishly intertwined, but one or the other undoubtedly came first.)
Experts say your erection problems probably have some psychological cause if:

• They occur only with certain partners or in certain situations (for instance, if you can get a rigid erection while masturbating, but not "vith your wife).
You also feel decreased desire for your partner.
You have problems ejaculating or reaching orgasm.
You have other bad feelings, like shame, guilt, hostility or depression.
By contrast, the impotence is probably caused by organic or physical prob¬lems if:
• The onset is gradual, with a progressive decrease in hardness and frequency of erections.
• It occurs in all situations- in the morning, during intercourse and during masturbation.

You can get an erection, but you can't seem to maintain it.
Your sexual desire is undiminished. Expect to be asked about all these areas as the doctor tries to determine whether your problem has a mental or physical basis.

The doctor may ask a few other questions about your life and health, too. Could a prescription drug you're taking be the problem? It's now believed that as many as a quarter of all cases of impotence are caused or made worse by medications, according to Paul Church, M.D., a urologist at the ew England Deaconess Hospital in Boston. (See "Medications.")

Could it be alcohol? A drink or two can have a mildly aphrodisiac effect, but heavy drinking is one of the most common causes of impotence. Long-term drinking can be disastrous, reducing the blood levels of male hormones and sapping sex drive. (See "AlcohoL")

Could it be smoking? Good erections require robust blood flow, but smoking constricts blood vessels, squeezing off circulation. That's probably why a very high percentage of impotent men are heavy smokers. (Quitting may not lead to a sexual renaissance, but it certainly can't hurt.)