Erectile dysfunction in old age is common, but what do doctors look for if a young man is struggling with ED? Learn about the common causes of ED in young men.
A lot of men might expect to deal with erectile dysfunction later in life. Half of all men between the ages of 40 and 70 experience occasional erectile dysfunction, and the frequency and severity of ED both increase with age. But what if you’re a man under age 40 wrestling with it? Turns out, you’re not alone.
A 2013 study published in The Journal of Sexual Medicine evaluated 439 men for erectile dysfunction and compared ED causes and frequency in men 40 or younger to men over 40. They found that 26 percent of the younger men had ED. Although these men were healthier and had higher levels of testosterone than the older men, they were more likely to be smokers or to have used illicit drugs. In almost half of the younger men with ED, the ED was considered severe.
“We used to think that ED in young men was 90 percent psychological, but we now know that most cases are caused by a combination of risk factors. Erectile function depends on hormones, blood supply, nerve function, and psychological health,” said Run Wang, MD, professor of urology at The University of Texas Health Science Center in Houston and director of sexual medicine at MD Anderson Cancer Center.
Erectile Dysfunction in Young Men: Medical Conditions
“With the success of Viagra-type drugs, there has been a tendency to start all patients with ED on one of these drugs and not look much further for a medical cause. But we now know that ED may be an early warning for heart and blood vessel disease, so it is important to look for common risk factors. These include high blood pressure, diabetes, medications, smoking, drinking, and drugs,” said Dr. Wang.
There are many other possible causes of ED in young men, such as back problems like lumbar disc disease, trauma, kidney and liver problems, sleep apnea, lung disease, thyroid disease, and other hormone abnormalities.
“If an obvious risk factor can be identified and treated, that’s the best place to start. If not, it’s reasonable to try one of the erectile dysfunction drugs for about a month. If the drug works, you may not need to go further,” said Wang. “But in about 40 percent of men, the drug does not work, and you may need to dig deeper to find a cause.”
The most common diagnostic test for erectile dysfunction is called penile ultrasound. This test uses sound waves to look for abnormal penile blood supply. Another test that may be done is nocturnal penile tumescence testing, in which a type of computer is attached to the penis to see if nighttime erections are occurring. If a young man is having nighttime erections but can’t get an erection during sex, a psychological cause becomes more likely.
“If Viagra or one of the other ED oral medications doesn’t work and other risk factors have been covered, options for treatment include a vacuum pump device, penile injections, pellets inserted into the penis, and if all else fails, penile implant surgery,” said Wang.
Erectile Dysfunction in Young Men: Psychological Factors
“If a young man does not have an obvious medical reason for ED, or if he does and his ED is causing significant distress or depression, consultation with mental health expert familiar with ED is an important part of treatment,” said Wang.
There are many factors that can lead to ED. “Psychological causes of erectile dysfunction in young men can include performance anxiety, guilt about sex in general, guilt about having sex with a particular partner, feelings of anger or resentment towards a partner, or simply finding a partner undesirable,” said Carole Lieberman, MD, a psychiatrist on the clinical faculty of the UCLA Neuropsychiatric Institute in Los Angeles.
“Men who have controlling personalities or who have suffered traumatic events that made them feel out of control may develop a fear of the loss of control that orgasm entails,” said Dr. Lieberman.
She offers these tips for addressing psychological ED issues:
Get help sooner rather than later. The more experiences of erectile dysfunction you have, the more anxiety you will develop about having sex, and this will lead to more erectile dysfunction.
Consider psychotherapy. If the problem seems like it’s psychological, such as performance anxiety, fear of loss of control, or guilt about sex, work with a psychiatrist or psychologist.
Consider couples counseling. This approach is helpful if the problem relates to feelings about your partner, such as guilt or resentment, you want to continue the relationship, and can be honest and open about it.
When to Seek Help for Erectile Dysfunction
Occasional ED is common in all men, including young and healthy men. But if you have a persistent or recurrent problem with initiating or maintaining an erection and it’s causing you or your partner distress, talk to your doctor. “Lack of nighttime erections is another cause for concern, said Wang. These occurrences serve to nourish the penis with oxygen and keeping the blood supply healthy, he explained. “Young men should get four or five of these a night. If you are not getting these and you are having frequent problems with ED, you need to check in with your doctor,” he recommended.
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