Erectile Dysfunction in Younger Men
Karim* is a thirty seven year old man, and has been struggling with erectile dysfunction ever since his college days. He’s used Viagra, and some of its many variants, but has had no luck in improving his condition so far. Although he’s sought medical advice from doctors, he found them to be largely dismissive, and sent him away after telling him the problem was probably caused by anxiety or stress.
”They brushed off my erectile dysfunction issues by saying they were all in my head, or down to stress”, Karim told us. “They said I was a healthy young man, and that ED doesn’t happen to people my age.”
Erectile dysfunction issues are far more prominent in men aged 50 or more. Karim doesn’t fit the typical profile. But that doesn’t mean that young people aren’t affected; the Journal of Sexual Medicine performed a study in 2013 and found that one in four patients newly diagnosed with ED are aged below 40. These are the men who don’t believe it will happen to them, and those least likely to talk about it. And because of that culture of shame and stigma, they’re left feeling deeply alone. Reddit has forums aimed at discussion of almost any topic imaginable, and in the /r/sex threads, one poster summed it up perfectly. “I’m 26”, he said. “This shouldn’t be happening to me”.
If we were asked to picture someone with ED, most of us would imagine a man much later in his life, perhaps in his 60s or 70s. Former US Presidential Candidate Bob Dole has made himself synonymous with Viagra by becoming their spokesman, for example, and he seems to fit the bill perfectly. But these stereotypes hide the truth; ED can occur to any age group, for a number of reasons. Not all of those reasons are immediately obvious. ED is, described basically, difficulty in achieving or maintaining an erection for the purposes of sexual activity. In 2007, a study in the USA put the number of sufferers at 18 million. Today, the National Institute of Heath believes that number to be closer to 30 million.
Doctors are seeing a gradual increase in the number of sufferers coming forward, and popular magazines like Vanity Fair note that women going on Tinder dates have been surprised by the frequency of the problem. One woman told the publication, “If a guy can’t get hard – and I have to say that happens a lot – they act like the world just ended”. Later in the piece, author Nancy Jo Sales speculates that causes among young men could range from anything between the chemical content of processed food to the anxiety of having to perform on a casual hookup. Nobody knows for certain what might cause the onset of ED among the young, but research has been done, and some potential causes have been highlighted.
There are two primary categories of ED: physical ED, and psychological ED. Before anybody starts diagnosing themselves with the condition, it’s very important to remember that almost everybody suffers with it on occasion. Only when it becomes recurrent or persistent should it be viewed as an issue.
Dr. Irwin Goldstein, who is the director of sexual medicine at San Diego’s Alvarado Hospital – as well as the director of San Diego Sexual Medicine – had this to say: “When it’s both persistent and consistent, chances are it has biological causes, regardless of a patient’s age. But the causes of ED can be psychological, too. As an example, if a man gets an erection when he’s alone, but can’t when he’s with a partner, it’s far more likely that performance anxiety or other psychological issues are the root cause”.
In older men, other health issues can have a knock on effect. Heart attacks and associated medications, high blood pressure and diabetes can all play a big role. Goldstein believes that actual physical trauma is more likely to be the cause in younger men. Sports injuries can be the culprit, as can actual injuries sustained during sex. Penis injuries do happen, and the standard ‘woman on top’ position causes more than any other according to a study conducted in 2015.
Lifestyle factors can come into play, too. Smokers, drug users and heavy drinkers are more likely to encounter the problem than men who don’t drink, smoke or use drugs. The phrases “whiskey dick” and “weed dick” exist for a reason. Ball State University’s Social Psychologist Dr. Justin Lehmiller, who also authors the “Sex and Psychology” blog, told Playboy magazine that people who smoke marijuana every day are three times more likely to suffer ED than people who never touch it.
Perception of ED among men who suffer from it changes with age. An older man might have a lifetime of great sexual experiences to look back on, and so is more accepting of problems in later life. Younger men haven’t had the opportunity to have all of those experiences, and so feel like they’ve been robbed of their sex life. That’s according to Rose Hartzell, a qualified sex therapist who also works with San Diego Sexual Medicine.
As another real life example, Gareth, 42, struggled to accept that he had ED for over eleven years before he eventually sought treatment. “I didn’t even know I could have it”, he says; “I thought I might be depressed, or just losing interest in my girlfriend”. However the problem became persistent, and his partner didn’t help, as she often taunted him for his inability to ‘get it up’
The connection between ED and pride is writ large and bold among people who are willing to discuss it. Going back to Reddit, and the /r/sex forums, a gay male said that the condition has ruined both his sex life and his social life together:- “I feel very ashamed when a guy is playing with my dick and I can’t get hard. So I just avoid hookups, and if I do hookup I make sure it’s with someone I have no social connection to.” Even when he’s offered sex, he feels too much shame to enjoy it. Single men stress about how and when to bring it up to new partners; it’s not exactly good first date talk.
Some professionals even feel that young men receive worse care than their older counterparts. Goldstein said “Young people get dismissed. They’re told it’s all in their head, or they should try another woman and everything will be fine” – unknowingly echoing the exact advice Karim received from his doctor. It’s all too easy for a doctor to assume that ED in a young man is psychological or temporary, creating a bias that acts as a barrier to effective treatment.
When treatment becomes available, though, there are several options – and they focus on the root cause, not the age of the patient. Goldstein explains:- “ED is not a diagnosis. It’s just a symptom. The patient is suffering from erectile dysfunction, and requires a diagnosis to identity the cause of that dysfunction”.
For physical problems, options that may be considered include injections to the penis or surgery to improve blood flow to the penis. Many medications also exist, from well-known names like Viagra and Cialis to lesser known ones such as Levitra. Any such medication should only be taken as a prescription – there are many hazardous potential side effects, and your doctor is best placed to know what to prescribe and what to avoid based on you as an individual.
Returning to Karim’s story, after trying Viagra and consulting a specialist, he finally found a doctor who could identify the root cause of his ED – a blockage in an artery right at the base of his penis, treatable with surgery. No longer living with ED, Karim says his life is dramatically improved. “Most of my partners eventually broke up with me because they didn’t understand the issue”, he said. “That doesn’t happen anymore”.
Lack of an understanding was also a problem that affected Gareth, who said “It definitely hurt my sense of masculinity, and my wife of the time made it much worse by saying that if I couldn’t get it up for her I must be gay”. Anxiety around a failure to perform often compounds the issue; men become obsessed by it, which adds to the pressure next time around, and making performing even more difficult.
Hartzell believes it’s best for medical professionals to help avoid these problems by occurring by involving both the patient and partner in therapy and treatment, giving the professional the chance to explain that the problem is not just the sufferer’s, both both of them together. “Some people think their partner’s erection is a symbol of how much they desire them, and that if it doesn’t work, they must be undesirable”, she explained. “That perception has to be challenged and changed. I often recommend couples to think outside of the box. Not all sex has to end in intercourse; look at sex as being based on pleasure rather than achieving full penetration each time. Oral and manual stimulation are just as important, and most importantly sex should be fun. Don’t make it part of a schedule or routine, go with whatever mood takes you”.
Gareth didn’t speak to any of his friends about his condition, because he suspected they wouldn’t understand. Because of this, his primary advice to other ED suffers is simply “You’re not alone”.
”There are so many men – millions – out there, all suffering the same problem”, he said. “Don’t be afraid of speaking to a doctor. One you get past the embarrassment, you can start to make a plan of action. That’s the only way your life will get better”.
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*Names have been altered