Good sex depends as much on game and confidence as it does on blood flow to the penis and the capacity for orgasms on demand. Membership in the foot-long club won't keep you from the sexual doldrums if you lack swagger and bravado. Many aging men have erection problems because of poor metabolic health. This creates a vicious cycle of erectile dysfunction, decreased sexual confidence and depressed sexual performance.

Viagra restores sexual confidence in many men. Generally, physicians start men on a 50-milligram dose and increase it gradually to 100 milligrams. A study sponsored by Pfizer, the maker of Viagra, showed that a starting dose of 100 milligrams produced more dramatic changes in sexual self-confidence and performance than a 50-milligram dose. Confidence is the key to success in the gym or in the bedroom. (Journal Sexual Medicine, 6: 2826-2835, 2009)