Several issues may contribute to this phenomenon
including performance anxiety, psychological disorders, and low testosterone
Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
- Recent studies show that one-quarter to one-third of men in their 20s and 30s experience erectile dysfunction (ED).
- ED can have many causes, both psychological and physical.
- ED can be an early sign of several serious health conditions, such as cardiovascular disease, so it’s important to get it checked out early.
- Several effective treatments for ED exist, from prescription medication to all-natural strategies.
Erectile dysfunction (ED) has a bit of an inaccurate reputation as a condition solely of older men. Although it’s true that ED is more common in men as they age, research shows that its prevalence is increasing among younger men, even in their 20s.
What is ED?
Erectile dysfunction happens when you can’t get or maintain an erection sufficient to have a satisfying sex life. ED can include softer erections, erections that don’t last as long, less frequent erections, or even a lack of morning erections.
During sexual arousal, arteries deliver blood to the penis, causing it to stiffen. ED can have psychological causes, like stress or performance anxiety. It can also have physical ones: ED can be an early sign of serious health problems like high blood pressure, diabetes, high cholesterol, or low testosterone. ED symptoms may occur long before more serious problems like a heart attack or stroke.
ED in young men
It may not be comforting to you if you’re experiencing it, but ED is very common. It’s the most common sexual dysfunction there is. The American Medical Association (AMA) estimates that more than 30 million American men experience ED. And that number is expected to double by 2025, largely because more guys in their 20s and 30s are reporting erectile dysfunction.
In fact, one study published in the Journal of Sexual Medicine showed that nearly 1 in 4 new cases of ED occurs in men under the age of 40. What’s worse, half of the young men in the study showed signs of “severe ED.”
What’s behind the increase? Alcohol, tobacco, and recreational drugs may be partly responsible. “What’s fascinating is that, what distinguished these men from older individuals, were lifestyle issues known to affect erections: smoking and illicit drug use,” says Michael Reitano, MD, Physician-in-Residence at Roman, about the study. “In other studies, alcohol consumption has been linked to ED. The young men were less likely to have other illnesses, to have leaner body masses, and to have higher testosterone levels.”
A more recent meta-analysis of studies found the number of cases was even larger: as much as 30% had issues with erectile function. The researchers called ED in young men “increasingly common.”
But it’s not something that has suddenly materialized. “The evidence is strong that ED has been an issue for younger men long before today,” says Reitano. “Addressing the issue has never been a strength of the medical system. ED is often difficult for patients to confront, it’s issue physicians rarely raise with men of any age—but particularly among the young—men seek health care infrequently compared to women, men don’t have the equivalent of a gynecologist with whom discussions of reproductive issues would be routine, and young men, in particular, may not have a trusted primary care provider.”
Part of the increase may be due to better awareness of ED leading young men to seek treatment. “Young people with ED may be more likely to seek help, compared to men of advanced years, as it may be even more disruptive to their life than it might be in older men,” says Reitano. “The fact that ED can be treated has also had an effect, in that men now realize that there is a solution and they needn’t suffer, making it more likely they would seek care.”
Think of ED as your body’s “check engine” light: Remember that ED can be symptomatic of a larger health issue, and when an otherwise healthy man in his 20’s experiences ED, it’s cause for concern. At any age, it’s important to address ED at the initial signs.
Common causes of ED
ED can be caused by a number of medical conditions or psychological issues.
Performance anxiety is when negative feelings about your sexuality cause you to become self-conscious and worry that you won’t satisfy your partner sexually. That low self-esteem can lead to ED.
Lifestyle factors. Smoking, drinking, and using drugs can increase your risk of ED.
Depression, schizophrenia, other psychological disorders
And then, anxiety, depression, and other mental health issues—plus the medicines to treat them—can cause ED. Scientists estimate that fear of sexual failure and other psychological factors might cause between 10% and 20% of ED cases. This can lead to a cycle: A depressed person might experience ED, which in turn can cause depression, anxiety, or relationship problems.
Some men develop a condition in which the foreskin becomes unusually tight, called phimosis. A different condition, called Peyronie’s Disease, happens when the penis becomes unusually bent or curved. Both can make erections painful and lead to ED. But both are easily treatable.
Medication. Certain medications, such as antidepressants, blood pressure drugs, antihistamines, tranquilizers, and appetite suppressants, can have the side effect of ED.
When arteries become narrowed or blocked, it can lead to cardiovascular disease. ED, caused by inadequate blood flow to the penis, can be an early sign. In fact, according to Yale Medicine, ED may be the only symptom of heart disease in young men.
Microvascular disease from diabetes. Diabetes is a condition in which blood sugar is too high. Over time, these elevated levels of sugar can damage the walls of the arteries throughout the body, including in the penis.
ED can be a sign of this neuromuscular disorder in which the immune system attacks the protective sheath around nerves, disrupting communication between the brain and various parts of the body. ED is common in MS, and several treatments are available. (Although having ED doesn’t mean you have MS, which is a rare condition.)
Spinal cord and nerve injuries
Injury to the spinal cord can harm nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.
Formally known as hypogonadism, a low testosterone level can have a number of sexual side effects, including low sex drive and ED.
Lifestyle changes. Losing weight, stopping smoking, reducing or eliminating the use of alcohol or illegal drugs, exercising, and consuming a healthy diet can all have a beneficial effect on ED. Read more about these 11 all-natural ways to protect your erection.
Medication and changes to existing medications
There are several effective medications available for ED. Known as PDE5 inhibitors, they include sildenafil (brand name Viagra), tadalafil (brand name Cialis), vardenafil (brand name Levitra), or avanafil (brand name Stendra). Your healthcare provider can also evaluate whether any medications you’re currently taking might be raising your risk factors for ED and adjust or change them as necessary.
Psychotherapy to overcome performance anxiety
If you suffer from sexual performance anxiety—or are feeling anxious about life in general—it’s a good idea to talk with a professional. Your ED and sexual performance anxiety could be part of generalized anxiety disorder, which has several treatment options, including talk therapy and anxiety medication.