› firstname.lastname@example.org 
Thanks for answering my question about performance anxiety ["Spectator Pumps," 2/21/07]. We solved the problem on our own. My girlfriend recognized that it was a confidence issue, so she went to the local sex shop and purchased an herbal male performance pill. We were both skeptical, but it actually worked within an hour. We proceeded to have awesome marathon sex. I had random boners for the next 48 hours.
My confidence was back pretty much instantaneously. We've had a healthy sexual relationship since then. We get a pill every now and again for kicks, but they are thankfully mostly unnecessary.
The "Mind-Blowing Sex, Not the Good Kind" Guy
Dear Good Guy:
I am simultaneously happy that you're happy and terribly sad that I ever read your follow-up letter. Why couldn't you have solved your problem with therapy or toys or pharmaceuticals or threesomes or gender reassignment surgery or anything, really, other than Dr. Woody's Hygienic Vega-Vital Specific Elixir? Now I have to burst your bubble, and you have no idea how much I don't want to do that.
Actually, you got past whatever was blocking you and now know you're capable of having mind-blowing sex, the good kind, not only with those bull-pucky pills but, more important, without them. You may be immune to bubble-bursting of any sort, which is great, however you got there. They're just, ugh, fake sex pills. I can't help imagining those creepy late-night pseudoceutical ads with the happy, happy wife with the unhinged jaw like an adder's and shuddering.
I have a story that is vaguely apropos if you'll just bear with me. Until fairly recently, I was plagued by crippling phlebotophobia merely thinking of blood draws turned me clammy and faint, and having one, well, I don't know what having one would have done, since I never let those needle monkeys get within a hundred yards of me. Since I wouldn't get a blood test, I couldn't get any serious medical care, which was fine with me but irritating to my partner, who preferred to think I'd make a good-faith effort not to drop dead on him without warning. So I resolved to do something about it, and since a couple therapist friends had been taking EMDR training, I decided to do that.
EMDR stands for eye-movement desensitization and reprocessing, a hypnosislike process that is supposed to heal posttraumatic stress and be useful for treating phobias, although there is no scientific basis for those claims. There are studies suggesting it works as well as any other therapy, but then there are also studies demonstrating that all therapy modes, semiscience and pseudoscience alike, work about equally well. The most likely explanation? Doing something helps. It doesn't matter what you do, just do something, the more formal the something, the better. Paying for the something also helps, if you ask me, since most people believe, deep down, that something for nothing is worth what you paid for it.
I knew all this but was determined to do EMDR (it seemed preferable to talk therapy, because I hate talking about stuff). I tried not to think about it too much. I also took my copy of Skeptic magazine with the cover story called "EMDR: Just a Big Fat Fraud?" or close enough, and buried it under a pile of old shopping circulars for the duration. I knew what it would say, you see, and I knew it was true: EMDR is bunk. It was the bunk that seemed most convenient at the time, though, so I willed myself to let it work. It worked OK (I've had umpteen blood tests since), although I'm fairly convinced that slipping $150 through a slot in the therapist's door every Wednesday at 3 p.m. would have worked equally well. Just do something.
"Just do something" also explains why some patients report an immediate improvement when they start antidepressants, even though the real effects may take as long as two weeks to kick in. There is also, more directly apropos here, the Viagra effect, whereby a filled prescription for magic beans reliably produces enormous, um, beanstalks, whether or not you ever open the bottle. You pointed out yourself that expecting to have disappointing, dysfunctional sex nearly guarantees that you will have it, so it shouldn't surprise you that merely knowing there's help available if you need it can be enough to break the cycle. If not taking a pill can fix you right up, it shouldn't be news that taking one, even a pharmacologically inert one, can work even better.
There is one strange addendum to that, though, if you'll stick with me: your snake oil pills may contain something besides snake oil, chalk, and blue dye number 26, and guess what that something might be? Consumer protection agencies both here and abroad have tested some alleged herbal supplements and found them to be adulterated with ... sildenafil citrate. That's Viagra to you, bub. You might be better off just getting the real thing. At least that way you'd know the dosage you're not taking.
Andrea Nemerson has spent the last 14 years as a sex educator and an instructor of sex educators. In her previous life she was a prop designer. And she just gave birth to twins, so she's one bad mother of a sex adviser. Visit www.altsexcolumn.com  to view her previous columns.