Erectile Dysfunction in Young Men – Is It Psychological?

Erectile dysfunction in young men may be on the rise

An image of a young man concerned about erectile dysfunction

Recent studies suggest that ED in younger men may be on the rise. An increasing number of young men seek out treatment and refuse to sweep these frustrating symptoms under the rug.

This means that young men with erectile dysfunction are most definitely not alone. They should feel comfortable researching erectile dysfunction and talking to their doctors about the condition.

It’s a common misconception that ED only happens after a man turns 50 or 60. The truth may be surprising: erectile dysfunction can happen to young men in their 20s, 30s, and 40s. Regardless of age, ED is a treatable condition as long as you understand the underlying causes and seek out the right treatments.

In this article, we’ll specifically look at erectile dysfunction in young men and how they can treat this frustrating condition.

How common is ED in young men?

While most men with ED are older, about 5% of men under 40 years have erectile dysfunction. Interestingly, some research suggests that young men are more likely to have severe ED symptoms— meaning that they always or almost always have problems with erections. In fact, in one study, nearly half of younger men with ED, had severe ED.

A chart that shows the prevalence of erectile dysfunction by age

Erectile dysfunction in young men is on the rise

Recent studies suggest that ED in younger men may be on the rise. An increasing number of young men seek out treatment and refuse to sweep these frustrating symptoms under the rug.

This means that young men with erectile dysfunction are most definitely not alone. They should feel comfortable researching erectile dysfunction and talking to their doctors about the condition.

What causes erectile dysfunction in young men?

While the possible causes of ED are the same regardless of age, some conditions are more common in young men. Seeking out the cause of erectile dysfunction is crucial as some young men may otherwise ignore ED.

A chart that lists the causes for psychological erectile dysfunction on young men

Younger men with erectile dysfunction are more likely to have an underlying psychological concern. Erections start in the brain and requires men to be open to becoming intimate. That means they must have low levels of stress to achieve an erection.

You should be able to devote needed brain resources towards pursuing sexual intimacy. Psychological barriers may prevent you from doing so, leading to erection issues.

Some common causes of psychological erectile dysfunction in young men are:

To learn more about psychological ED, its causes and treatments, check out this article that goes into more detail on the topic.

While physical causes of erectile dysfunction are more common in older men, they cause ED in young men too. It’s even more important to uncover any physical conditions underlying ED in young men so they can prevent more serious problems before they happen.

Symptoms and diagnosis for psychological ED in young men

So how can you tell if you have psychological ED? Dr. David Kaufman, an Andrology specialist and the Director of Urology at Maiden Lane Medical in NYC, explains “An increasing number of men under the age of 35 are presenting to my clinic complaining of erectile difficulties. The cause of ED in the vast majority of these men is psychological.

This is what I like to call a ‘big head problem, not a little head problem.’ 

A young man in bed waking up in the morning

Unless the patient is a juvenile diabetic (or early onset Type II diabetic), has a significant vascular or neurologic disease which is very unlikely in this age group, or was the victim of serious pelvic trauma, the most common cause of these erection problems is ‘performance anxiety.’ 

Careful questioning of the patient usually reveals the following indicators of psychological ED:

  1. Normal erections in fairly recent past relationships
  2. Normal early morning erections
  3. No problems achieving erections w/ masturbation
  4. Intermittent symptoms, sometimes everything is fine, other times not

Typically, the patient will have experienced an unsuccessful sexual event in the recent past, possibly due to fatigue, too much alcohol on board, work-related stress, relationship issues, etc. and he cannot stop rehashing that embarrassment in his mind in subsequent sexual experiences, so that a failed erection becomes a self-fulfilling prophecy.”

If you have morning erections than ED is probably psychological.

How do you treat psychological erectile dysfunction?

Younger men with psychological ED have a lot of options for treatment— and a lot or opportunities to prevent it in the first place.

Here is a list of steps you can take to treat erectile dysfunction, depending on your situation:

  1. Treat performance anxiety

    Performance anxiety is real and can lead to a self-fulfilling prophecy. It’s a common cause for psychological erectile dysfunction. To treat performance anxiety, men have to get at the root cause to break the cycle of rumination and worry.

    a chart that shows the steps of the sexual performance anxiety cycle

    Guided imagery is an effective method for reducing performance anxiety using visualization. Mindfulness meditation is also a very powerful technique for overcoming performance anxiety. Practicing mindfulness meditation allows the mind to release unhelpful thoughts and unconscious stresses.

    A 2018 study found that 9 out of 10 of men with psychological ED were able to overcome it using mindfulness meditation.

    In some cases, sexual cognitive behavioral therapy (CBT) with a sex therapist can help manage performance anxiety. It is an excellent option for dealing with erectile dysfunction, especially if your partner is willing to get involved.

  2. Get relationship help

    If relationship problems may be the underlying cause of ED, speaking with your partner is a good idea. Sometimes, simply opening up the line of communication is enough to relieve some of the worries and concerns associated with sex.

    In more complex situations, seeking the help of a sex or relationship therapist might be necessary. Therapy often includes both sexual CBT and sensate focus.

  3. Make lifestyle changes

    a chart that lists the lifestyle changes a man can take to improve erectile dysfunction

    In younger men, ED is more common in smokers, illicit drug users or sedentary individuals who spend a lot of time in front of the TV or online.

    Maintaining a healthy diet and exercising regularly will help reduce general stress and anxiety and will make you feel better about yourself.

  4. Short term ED medication use

    In some cases, using ED medication as a means to regain confidence can help men overcome anxiety-induced erectile dysfunction.

    Dr. Kaufman elaborates, “Short term prescribing of adequate doses of PDE5 inhibitors (sildenafil, tadalafil) so that the increase in blood flow to the penis stimulated by the medication overwhelms the patient’s performance anxiety issues, can result in a successful erection and positive sexual experience.

    I encourage patients to titrate the dosing of these meds upwards to maximal clinical doses if necessary until the desired erection is achieved.

    I tell my patients to continue using this medication short term until they are convinced that no matter where his head is at, with the medication he is assured of still having a successful sexual experience.

    Eventually, the patient is told to wean off the medication, but to ‘keep it handy’ so that he knows the drug is there for ‘backup’ just in case.

    This knowledge is typically able to overwhelm the performance anxiety and give the individual the ‘mojo’ he needs to continue having successful erections without the need for pharmacologic backup.”

Studies show that combining proven treatments in these cases— such as sexual CBT and pills— can be a better treatment for erectile dysfunction in young men. In fact, combining treatments increase men’s sexual satisfaction compared to a single treatment, even if there is no underlying physiological cause.

The point is that there are a lot of ways for young men to treat erectile dysfunction. There is no reason to feel hopeless that your condition can’t be treated.

To learn even more about your options for treating ED, read this and get a more in-depth overview of the possibilities.

Summary

Erectile dysfunction in young men is not the unicorn some may think. ED is not just a problem of old age. Young men can learn about the signs and symptoms of erectile dysfunction so that they are empowered to deal with it head-on.

Erectile dysfunction can be anxiety-provoking and confusing to young men. Arming yourself with accurate information can help relieve the stress of the condition and get you on the road to recovery. Stay educated and take some of the steps we discussed to prevent and treat erectile dysfunction and get back to a healthy and enjoyable sex life.

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