<s>[INST] Hi doctor, I am concerned about ED. I am 51. I am fit but have hypertension that is controlled using 5 mg of Bystolic daily. BP generally runs 120/77 but can be higher depending upon stress levels. My most recent physical showed healthy levels of cholesterol and blood sugars. I do however have anxiety issues. Until last Thursday, I generally woke once or twice each night with strong erections. On Wednesday, I had sex with my wife that morning and then masturbated later in the day. I woke up on Thursday with only a weak morning erection. I was not too concerned but I noted it. (I have had a fear of ED since turning 50). Friday, I had weak morning erection and that night, I had no real libido and when I tried to force the issue, I could not get an erection. I woke up Saturday morning with a moderate erection and was able to achieve 80 or 90 percent hardness and ejaculate. I was still concerned about not being doing so the night before. Sunday morning, I awoke with a moderate morning erection and masturbated to 70 or 80 percent without ejaculation. Monday, there was no morning erection, but I was able to get to get myself fairly erect. Tuesday nothing. Wednesday, no morning erection but I could masturbate to about 70 percent. Thursday, no morning erection but I masturbated to about 70 to 80 % and ejaculated. Each of these times the erection deflated fairly quickly once stimulation stopped. Last night, Thursday night, I was able to masturbate to about 80 percent without ejaculation. However, it deflated quickly again. No morning erection today. Throughout all of this, my libido has been subpar and my anxiety has been fairly high. As I mentioned, I have had a fear of ED. This came on so quickly, it has me very concerned. My question for you is, given what I am experiencing, do you think there is a physical cause of this or is it simply my anxiety about erectile dysfunction? [/INST] Hello. I have gone through your description and the likely cause is stress and anxiety. These factors quite commonly affect sexual performance, libido, and erections. Considering your libido was also low during this period, it is likely a stress and anxiety-related issue only and unlikely to be erectile dysfunction (ED). Also, normally in humans, there exists some period during which overall sexual activity is low which is influenced by multiple day to day and hormonal factors. Also, to consider the possibility of erectile dysfunction, one should have a consistent and recurrent inability to sustain or acquire erections and cannot jump to a conclusion of ED over such a short period. So, overall, I do not think this is ED but stress-related and should improve in a week or two. If you are not having libido, then better not force yourself for masturbation and sex, and just wait for few days and then you will certainly come back with stronger desire and erections. For more information consult an internal medicine physician online --> </s>