Flagging sexual desire is a common problem in patients I see. And I’m not surprised. Sexual desire and sexual pleasure are intimately connected to feelings of individual vitality and couple connection.

But what can you do about a loss of desire?

From time immemorial, humans have searched for aphrodisiacs that could increase or revive sexual desire.

Inevitably, the quest for aphrodisiacs has turned up some suspicious and even ridiculous candidates. Alleged sexual stimulants have included the drugs ecstasy (MDMA), cocaine, LSD, and Spanish fly (cantharides), as well as foods like bananas, asparagus, ginger root, oysters, potatoes. In some cultures, the ground horn of a rhinoceros is said to stimulate sexual desire.

And around these parts, people often consider the prescription drugs for erectile dysfunction to be aphrodisiacs. (E.D.) –Viagra, Levitra, and Cialis, are often thought of as aphrodisiacs.

Technically, these drugs — including Viagra, Levitra, and Cialis — are not aphrodisiacs. They do not increase sexual desire. What they do is to make it easier for many men to get and keep an erection by facilitating genital vasocongestion, which is the swelling of tissue due to increased blood flow.

However, I have seen these drugs act almost as if they were aphrodisiacs. For young men, middle aged men, and even older men, the dread of not being able to get an erection — or not being able to keep one — is enormous.

Consciously, or unconsciously, when these men with unstable erectile capacities are paired with partners who have a high sex drive and desire for intercourse, their fear of failure is enough to depress their wish for sexual interactions.

I have seen men with erectile instability unconsciously pick fights with their partners, avoid going to bed at the same time as their partners become workaholics, and retreat into alcohol abuse or an overuse of pornography.

In other words, erectile instability can cause men to avoid sex. I have often heard men with erectile instability say, “I don’t want to start something I can’t finish.”

Many sex therapists ambivalent feelings about ED drugs. I have seen them make a huge difference in a couple’s sexual life, because they can give men the confidence to be emotionally available, affectionate, and brave enough to initiate sex.

On the other hand, I don’t want my patients to become dependent on ED drugs. By themselves, they are not the long-term answer to erection problems.

Combining such drugs with frank and productive talks about what each partner wants, what gives pleasure for themselves and others, and what sexual behaviors are pleasurable even if erections don’t cooperate will actually get couples the best benefit over the long haul.