If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
What is ED?
Erectile dysfunction (ED) occurs when you can’t get or maintain an erection sufficient for satisfying sex. That might include erections that don’t last as long as you want or aren’t as firm as you’d like. ED is the most common sexual dysfunction: In fact, it’s estimated that more than 30 million American men have experienced it (Nunes, 2012).
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.
- 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.
ED in young men
A number of studies conducted in the past decade have found a sharp increase in the number of men under 40 who are reporting ED—a condition once considered exclusive to older men. For example, an Italian study published in 2013 noted that, out of 439 men who had erectile dysfunction, 114 (26%) were younger than 40 (Capogrosso, 2013). And nearly half of those young men had “severe” ED, according to the International Index of Erectile Function (IIEF), a 15-item questionnaire that assesses erection frequency and quality.
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.”
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But skyrocketing rates of ED among younger men, isn’t something that has suddenly materialized over night. “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.”
ED can be your body’s “check engine light”—it may be an early sign of a larger health issue, such as heart disease, low testosterone, high blood pressure, high cholesterol, or diabetes. The blood vessels in the penis are smaller than in other parts of the body, so ED symptoms sometimes occur before more serious problems such as a heart attack or stroke. When an otherwise healthy man in his 20s experiences ED, it could be cause for concern. Talk with a healthcare provider as soon as possible.
Common causes of ED
Researchers haven’t definitively determined that the rising numbers of young men reporting ED is caused by something specific that’s going on in that age group at this cultural moment. There are several theories. For example, some scientists think the rise of internet porn might be affecting men’s psychological approach to sex and dampening their IRL sex lives, though a 2019 review of studies found insufficient evidence to support that hypothesis. So let’s take a look at some other possible factors.
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.
Obesity and the use of alcohol, tobacco, and recreational drugs—four proven causes of ED—may play a part, but that’s far from conclusive in this age group, and cigarette use is (thankfully) declining among guys in their 20s.
Depression, schizophrenia, other psychological disorders
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.
As mentioned above, 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.
However, there are some factors that have been proven to cause ED, no matter what your age. A healthy erection requires healthy blood flow. Erectile dysfunction can be related to health conditions that impair blood circulation.
While a number of things could be causing your ED, a spectrum of solutions also exist. Here are a few things to consider.
Take better care of yourself
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 and may be all you need to do to regain erectile function. 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 low testosterone is responsible for your ED, testosterone replacement therapy (TRT) can boost your testosterone levels via injection, a wearable patch, or gel applied to the skin. For some men with ED, using a device such as a penis pump, cock ring, or—in severe cases—a surgically placed penis implant has been effective in restoring sexual function.
Some men have found natural remedies for ED to be effective. Some studies have shown that certain supplements (such as DHEA, ginseng, L-arginine, L-carnitine, and yohimbe) may be helpful. Read everything you want to know about natural remedies for ED here.
If you’re experiencing ED, talk with a healthcare provider. They’ll help you find a solution that’s right for you—and potentially catch other health problems before they become bigger issues than they need to be.