Dear Neil: About a year ago I began having problems in getting an erection. Also, while making love, I have begun to go soft. I went to a doctor who gave me some medicine, but it didn’t help. He told me that I may have to have some tests done. What would you suggest?

Lexington, Kentucky

Dear Lexington: By all means, pursue the tests your physician recommends. If your doctor isn’t a urologist, it would be wise to find one. He or she should be able to diagnose what’s wrong and offer you options that will solve the problem. Some of the more common options available to men who have a hard time getting it up—or keeping it up—include penile injections, vacuum pumps, penile suppositories, medications (such as Viagra and Yohimbine) and penile implants.

Lifestyle options that have a high likelihood of causing impotence include cigarettes, too much alcohol, high cholesterol, being overweight, and not physically staying in shape through regular exercise. All of those behaviors contribute to your blood vessels constricting, which in turn inhibits blood flow into the penis.

Marriage therapy and sex therapy are often useful in solving this problem. Such therapy attempts to help the two of you acknowledge and accept joint responsibility for solving the problem as a couple, offers you ideas about how to erotically stimulate your partner (and be stimulated), addresses performance anxieties and fears, and attempts to treat whatever relationship conflicts the couple might have. Unresolved conflicts, poor communication and buried anger are often responsible for low sexual desire or sexual dysfunction.

Dear Neil: I have been separated from my wife for six months. During that time we have had some horrendous arguments. Is it common for separating couples to experience such a broad range of feelings and emotions?

Confused
Wellington, New Zealand

Dear Confused: The single most difficult part of the entire divorce process is separation. It is common for people to feel great panic, fear, grief, remorse and anger. Feelings of betrayal and abandonment are very strong, and you have an incredibly strong desire for revenge. Helpless and hopeless emotions often emerge. You feel lost and incredibly lonely, and there is often a fear of what the future holds.

Separation throws some people to the edge of sanity. Because you’ve lost your center of gravity, you feel very disoriented, and you do not feel like you are yourself. You lament how angry, frightened and depressed you are. It makes many people feel as if they have gone crazy.

Combine all that with finger-pointing, fault-finding and blaming, and you have all the ingredients in place to start World War III. Both of you are hurt and angry, and both of you are likely feeling emotionally misused, abused and discarded.

If you’re wanting to reconcile, find a neutral and skilled third party who can help the two of you dialogue more effectively, and to acknowledge your individual roles in causing the problems you are going through. You need assistance in resolving your differences, soothing ruffled feathers and angry emotions, and help in making amends to each other.

On the other hand, if you’re attempting to get divorced, disentangle from your wife and quit engaging in conversations that hurt.