Causes of Erectile Dysfunction in Your 20s: Is It Normal?

A man in his 20s, sitting in his bedroom, thinking about the possible causes of ED in your 20s

As a sex therapist, I have seen an increasing number of young men in their 20s experiencing erectile dysfunction. This can be a frustrating and embarrassing issue for many men, and it’s important to understand how common it is.

In this article, I’ll discuss some of the potential causes for ED in younger men, as well as what can be done about it.

Can You Have Erectile Dysfunction in Your 20s

I often get asked whether it is possible to have erectile dysfunction (ED) in your 20s. The answer is yes, it is possible. While ED is more commonly associated with older men, it can affect men of all ages, including those in their 20s.

It’s important to understand that experiencing ED occasionally is quite normal. It could be due to stress, fatigue, or other temporary factors. However, when ED occurs frequently or consistently, it could indicate an underlying issue.

With the right support, many young men can regain their confidence and overcome this challenge. Remember, erectile dysfunction is a treatable condition, and it doesn’t define your self-worth or ability to have satisfying sexual experiences.

Is Erectile Dysfunction Common in Your 20s?

Erectile dysfunction is more common in men in their 20s than you might think. While studies like this one from the American Journal of Medicine suggest that only 5.1% of men ages 20-39 experience ED, I see increasing numbers of men present with concerns around ED.

It’s important to note that you don’t have to be officially diagnosed with ED to experience erection issues. Many young men may experience occasional difficulty getting or maintaining an erection, and this is completely normal.

However, if you find that it is becoming a persistent problem that is affecting your sex life and overall well-being, it may be time to seek professional help from a urologist and/or sex therapist.

Symptoms of ED in Young Men

The symptoms of ED in young men can vary, but the most common symptom is the inability to achieve or maintain an erection during sexual activity.

One significant symptom is struggling to maintain a consistent erection that hardens enough for sexual activity. Men may find their erections to be softer and shorter-lasting than usual. Also, they might have a hard time achieving an erection in the first place.

Another frequently observed symptom is a decrease in sexual desire, which may be partially or entirely related to anxiety about sexual performance.

In most cases, if you can get an erection while you’re sleeping or when you wake up, but struggle during sexual activity, this could indicate a psychological issue. On the other hand, if you’re unable to achieve any erections, even during sleep or first thing in the morning, you may be dealing with physical ED.

It’s important to note that there’s often an overlap between both underlying physical conditions and psychological factors. Sometimes, anxiety and stress about sexual performance can lead to physical symptoms, and vice versa.

Causes of Erectile Dysfunction in 20s

In this section, I will discuss some of the causes of ED. The causes are listed by the order of their likelihood to appear in men in their 20s based on my clinical experience:

Psychological Factors

Psychological factors such as anxiety, stress, and depression can also contribute to ED. When a young man is going through a tough time emotionally, his sexual function may be affected.

Performance anxiety

Performance anxiety is the most common psychological explanation. Many men feel pressure to perform well in sexual encounters, which can create stress and eventually lead to ED. Once erectile difficulties occur, performance anxiety heightens, creating a positive feedback loop of anxiety and disrupted performance. I’ve noticed that my clients who experienced performance anxiety often found success with relaxation techniques and open communication with their partners.

Relationship issues

In some cases, relationship issues may be the culprit. For instance, being cheated on or having unresolved conflicts with a partner can manifest as ED. Developing healthy communication and rebuilding trust are critical in these situations.

Condom-related erectile dysfunction

Some men may lose their erection when putting on a condom due to anxiety or discomfort. It’s important to find the right size and material and practice using condoms to increase comfort and confidence.

Porn-induced erectile dysfunction

Porn-induced erectile dysfunction has become a more prevalent issue among younger men. Some experts claim that excessive consumption of pornography leads to overstimulation of the brain’s dopamine system and can affect sexual performance with a real-life partner.

Others say that young men who get their sexual education from porn develop unrealistic expectations of sex, which leads to performance anxiety.

Lifestyle Factors

Lifestyle factors such as smoking, lack of exercise, alcohol use, and drug abuse can also cause ED. Smoking can damage blood vessels and reduce blood flow to the penis, while excessive alcohol consumption can affect your nervous system and lead to ED. Recreational drugs such as cocaine can also cause ED by affecting blood flow to the penis.

A recent survey found that only 15% of millennial men do not drink at all on first dates, and the majority of men have at least two drinks.

Medical Conditions

Medical conditions such as diabetes, high blood pressure, kidney disease, and high cholesterol can all contribute to ED. Even though these conditions are less common in young men, maintaining good health through regular exercise and a balanced diet is crucial in preventing their onset.

Hormonal Imbalance

Young men may also experience hormonal imbalances such as low testosterone levels. This can contribute to ED but is less likely in their 20s compared to older men.

Other Factors

Other factors such as Peyronie’s disease, which causes curvature of the penis, and certain prescription medications, such as antidepressants, can also contribute to ED.

How Do You Fix Erectile Dysfunction in Your 20s

ED can be caused by a variety of factors, including psychological and medical issues. In this section, I will discuss the most effective ways to manage ED in your 20s.

Mindfulness Meditation

Mindfulness-based meditation has been proven to be a successful treatment for ED, and this is supported by research. A 2018 study demonstrated that 90% of men with psychological ED experienced positive outcomes after just four weeks of mindfulness practice.

This method helps men concentrate on the present moment during sex, decreasing anxiety and encouraging relaxation, ultimately aiding in preventing erection problems.

Mindfulness meditation is effective in both eliminating performance anxiety, and in fighting chronic stress and depression.

Many of my patients have found this method to be effective, and I highly recommend giving it a try with the help of a trained professional.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a useful approach for addressing the psychological aspects of ED, such as negative thoughts and performance anxiety.

This can be practiced with the assistance of a therapist or through self-help techniques like mindfulness-based CBT.

 A recent 2020 study, concluded that CBT can be a promising treatment choice for young men who experience psychological ED.

Psychotherapy and Counseling

If self-help techniques don’t work, psychotherapy and counseling can be effective for ED caused by psychological issues. A therapist can help you identify the underlying causes of your ED and develop strategies to overcome them.

Effective Communication in Relationships

Relationship problems can also contribute to ED. It is important to communicate openly and honestly with your partner about your feelings and concerns.

In many cases, if ED is caused by performance anxiety, simply sharing your concerns with your partner can help eliminate the issue.

In other cases, feelings of anger or resentment between partners leak into the bedroom. When your head is elsewhere, it is hard to stay aroused enough to have an erection. Resolving conflicts can help sort this issue out.

Healthy Lifestyle Habits

Adopting healthy lifestyle habits can also help improve ED. Some tips for healthy living include:

  • Limit alcohol consumption
  • Quit smoking
  • Exercise regularly
  • Eat a healthy diet
  • Maintain a healthy weight

In my experience, men in their 20s tend to drink quite a lot when dating to reduce stress and loosen up. The problem is that alcohol can also make it harder for you to get or maintain an erection, and in many cases, all you need is one bad sexual experience to fall into the vicious cycle of performance anxiety.

Oral Medications

Oral medications, such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) are often prescribed for ED. These medications work by increasing blood flow to the penis.

However, it is important to note that these medications are not effective for all men and are particularly less effective when ED is caused by a psychological factor.

Always consult your doctor before undergoing any medication regimen. Though sometimes the placebo effect of these drugs can help young, healthy men, there is generally not a need for medication at this age.

Vacuum Devices

Vacuum devices, also known as penis pumps, can be used to treat ED. These devices work by creating a vacuum that draws blood into the penis, causing an erection. Vacuum devices are safe and effective for many men with ED, though some people find them cumbersome and disruptive

Injections and Suppositories

Injections and suppositories can also be used to treat ED. These medications are inserted directly into the penis and work by increasing blood flow. However, they can be painful and may cause side effects.

Surgical Treatments

Surgical treatments, such as penile implants, may be recommended for men with severe ED who do not respond to other treatments. Penile implants are devices that are surgically implanted into the penis and allow for an erection to occur.

Testosterone Replacement Therapy

Testosterone replacement therapy may be recommended for men with low testosterone levels. Low testosterone can contribute to ED. Testosterone replacement therapy can help increase testosterone levels and improve ED.

Shockwave Therapy

Shockwave therapy is a newer treatment for ED that uses low-intensity shockwaves to improve blood flow to the penis. This treatment is still being studied, but some experts believe early results are promising.

Beware of Over the Counter Natural Remedies

There are many over-the-counter natural remedies that claim to treat ED. However, these remedies are often unproven and may be harmful. It is important to talk to your doctor before trying any natural remedies for ED.


Experiencing ED in your 20s can be distressing, but there are effective treatments available. ED can be caused by a variety of factors, including psychological and medical issues. With the right approach, most men in their 20s should be able to treat the root cause of their ED and get their erections back!

About Bailey Hanek PsyD

Clinical Psychologist and Certified Sex Therapist

Dr. Bailey Hanek is a clinical psychologist and an AASECT-certified sex therapist. She serves as a professional consultant for Between Us Clinic. Dr. Hanek provides sex therapy and general psychotherapy to adults in her private practice. In addition, she works to increase access to information about relationship and sexual health through her founding role in The Relationship Coaches.