Dealing with ED in your 20s and 30s

You probably think of erectile dysfunction (ED) as a condition that mainly affects older men. But it can happen to men in their 20s and 30s, too. Some studies suggest that up to 30% of younger men deal with ED.

You might assume that ED issues in younger men are just one-off events and that the problem will go away on its own. It’s true that having erection trouble every once in a while isn’t necessarily cause for concern, according to the Mayo Clinic. But that doesn’t mean guys under 40 should just accept erectile problems. Understanding why ED happens when you’re young can get you back on track in the bedroom.

Psychological causes of ED in young men

ED in younger men often has a psychological cause, says Tracy Gapin, MD. He’s a board-certified urologist and founder of the Gapin Institute in Sarasota, Florida. Some of the ways that your brain can get in the way of your erection include:

Performance anxiety. This happens when you worry so much about having an erection that you can’t get one. “It’s actually mental. Guys will have this vicious cycle where they occasionally can’t perform for whatever reason, and it gets in their head that they can’t perform,” Dr. Gapin says.

Being embarrassed about the problem just makes it worse. Younger men can have “a feeling that it’s not normal, that I’m too young to have this,” says Dr. Gapin. This can lead to insecurity and depression.

Using pornography. Frequent use of pornography might contribute to ED in younger men. “They especially use porn with masturbation,” says Dr. Gapin. “It causes the brain to require more and more dopamine stimulation to cause pleasure.” (Dopamine is a brain chemical that’s connected to sexual arousal.)

When you have intercourse with a partner in a real-world situation, it doesn’t quite live up to the fantasies. And that means the dopamine stimulation isn’t as high. This can lead to problems getting and maintaining an erection. The result: You don’t want to initiate sex because you’re afraid you won’t be able to perform. It’s that vicious cycle again. In these instances, Dr. Gapin often recommends counseling or coaching to help resolve the issues.

How medication can help. A prescription for a medication such as sildenafil (Viagra^®), vardenafil (Levitra^®) or tadalafil (Cialis^®) could also be a solution if you’re experiencing psychological ED issues.

In some cases, the medication helps guys gain confidence as well as improve erections, says Marc Cohen, MD. He’s a urologist in Sarasota, Florida, and a medical adviser at Bastion Health, which specializes in male fertility and prostate health. “The patient sees a response and gets encouraged,” which in turn boosts confidence and reduces performance anxiety, he says.

It’s important to get your own prescription and not borrow a friend’s medication, cautions Dr. Cohen. That’s because the individual response to dosage can vary, and the medication can interact with other medications you take. (Find out which ED medication is best for you.)

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Lifestyle factors that can cause ED

Party people, beware. Smoking, drinking and using recreational drugs can definitely affect your erections. Consider:

• Alcohol. It depresses your central nervous system, interfering with the brain and hijacking the signals that help lead to an erection.
   
• Heavy cigarette smoking. This is a risk factor for ED in younger men, and it’s harmful for your health overall. Smoking increases your risk of vascular disease, hardening of arteries and narrowing of blood vessels (all issues related to blood flow). And all of these conditions increase the risk of erectile problems.
   
• Marijuana. ED is twice as high in guys who smoke marijuana than in those who don’t, according to a 2019 review study in American Journal of Men’s Health.
   
• Illicit drugs. Cocaine, opiates, amphetamines and other illicit drugs can also cause ED, according to the Cleveland Clinic.

Be honest with your doctor if you use of any of these substances. Your doctor needs to have this information before prescribing any medication. He or she can also suggest lifestyle changes that may help improve your ED.

Potential physical causes for ED in younger men

There are some underlying health conditions in younger men that can contribute to ED. These include:

• Cardiovascular problems
• High blood pressure
• Diabetes
• High cholesterol
• Congenital heart defects

One of the most serious underlying causes is heart disease. The ED itself can be a warning sign that you’re at risk for a heart attack. It’s true that younger men have an overall lower risk of cardiovascular events. But this could be an early opportunity to discuss erectile problems, as well as any cardiovascular issues before they become more damaging.

Physical factors can be overlooked in younger men, so a face-to-face doctor’s appointment is valuable, says Dr. Cohen. Your doctor can do a general exam and health check to identify problems or rule them out. (Read more about the physical causes of ED.)

Sometimes treating the underlying health problem can improve ED issues. Your doctor will also consider other medications you take. For example, antidepressants can dampen your interest in sex.

The bottom line: You don’t have to suffer with ED problems. Whether the cause is related to physical, lifestyle or psychological issues, you have a wide range of treatments and tools to improve your sex life. Addressing the problem now can even benefit your health later in life.

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Additional sources
Prevalence: Sexual Medicine Reviews (2017). “Erectile Dysfunction in Young Men — A Review of the Prevalence and Risk Factors”
ED basics: Mayo Clinic (n.d.). “Erectile Dysfunction”
Illicit drug use: Cleveland Clinic (2019). “Erectile Dysfunction”