Twenty years ago I had a bad breakup with the mother of my children. The stress and guilt of our split caused me to experience erectile dysfunction. I consulted a doctor and was prescribed Viagra. The day after getting the meds I had very good sex with my girlfriend, but after about a month I decided to try without the tablet and failed miserably. So I went back to taking a tablet every time I have sex. I get them online now so I don’t even speak to a consultant. I take half a pill 20 minutes before sex, without telling my partner; however, I get stressed at the thought of it not working and sometimes get heart palpitations. I wonder if I should go back to the doctor and get an implant or another form of medication. My lover thinks I am a virile man and would be shocked if she knew I took the blue pill.

The heart palpitations you are describing may be of concern, so please arrange an in-person consultation with a doctor immediately. Other than that, your health is your private business. If it does not affect another person you do not need to share your medical facts – or your medication protocol – with anyone else. One of the useful things about ED meds is that they can reduce erectile anxiety – but this doesn’t seem to be working in your case. And you are doing your best to “perform” well but that stressful focus is not necessarily the most productive path to sexual pleasure, satisfaction and true intimacy. Pause and think about what genuinely gives you pleasure; I bet it is not only about erectile perfection. You deserve far more relaxed erotic fun.

  • If you would like advice from Pamela on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com (please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online. She regrets that she cannot enter into personal correspondence. Submissions are subject to our terms and conditions.

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