Psychological Problems Often the Cause of Erectile Dysfunction in Younger Men

Men in their 20s and 30s are usually in their sexual peak. But some men under the age of 40 may experience sexual deficiencies such as erectile dysfunction or low sex drive.

Although pre-existing health conditions may be to blame, erectile dysfunction in younger men is most often the result of psychological problems, according to experts.

Erectile dysfunction, ED for short, is the inability to attain or maintain a penile erection. In order for the penis to maintain an erection, it must stimulated by nerve signals that prompt the blood vessels in the penis to expand so blood can fill it. If the blood vessels are not fully compressed, an erection may not be obtained or may not last long.

Recent statistics show that 18 million men in the U.S. have erectile dysfunction. Sexual dysfunction in men increases with age, with the majority of men experiencing this disorder over the age of 65, according to a recent study by John Hopkins Bloomberg School of Public Health.

Cause and effects

Erectile dysfunction in men under 40 is very rare, particularly when there are no preexisting health issues, according to Dr. Jeffrey K. Cohen, a urologist for the Triangle Urology Group in Pittsburgh, Pa

“The largest cause in this group is psychogenic,” said Cohen. “The other is vascular complications resulting from diabetes. We don’t see much of vascular diseases so more of the cases are a result of what is between the ears. You don’t see a lot of erectile dysfunction in men under the age of 40. It’s more a matter of perception of how they are functioning. They still want to be 16, and that’s just not possible.”

Psychological factors that can affect this age group include:

— Performance Anxiety

— Unrecognized homosexuality

— Death in the family

— Death of a spouse

— Child being ill

— Financial problems

Dr. Tony Sliwinski, a urologist at the Virginia Urology Center, agrees that it’s all in the head with younger men.

“I'd say this is true in at least 10 to 25 percent of all men in their 30s and somewhat less in men in their 20s who experience ED,” he said.

He added that roughly 75 percent of all men who have diabetes have ED, according to figures from the Men's Sexual Health Collection in 2006.

“Erectile dysfunction is a prevalent disease estimated to affect half of all men aged 40-70,” said Sliwinski. “In the younger men, prevalence data is not well studied, but it easily is approaching the same numbers as a 40-year-old.”

Sliwinski said that the following are some other possible causes of ED:

— Smoking: Smokers are 1.5 times more likely to have ED than nonsmokers, according to a 2006 study published in the Journal of Urology.

— Depression and ED are also commonly correlated. The Massachusetts Male Aging Study demonstrated a 1.8-times greater prevalence of ED in depressed patients. Erectile dysfunction is known to exacerbate depression, and the successful treatment of ED improves depression in multiple studies.

“Other risk factors in younger, as well as older, men are hypertension and an elevated BMI,” said Sliwinski. “Studies have correlated the two and lowering blood pressure and reducing BMI into normal ranges has a significant impact on return of function.

My biggest concern is the denial my younger patients have that they have a problem.”

Most of the time, according to Cohen, “The reason behind the manifestation of sexual problems like erectile dysfunction in younger men is that they really need to talk to somebody — a urologist, psychologist. It’s a very difficult conversation to have with friends or your religious clergy. You can’t just say to anybody, ‘Hey, I’m having problems at home.’”

Traumatic events can also reappear over time with little notice, he said, and have a significant impact on their sex lives. He said one patient’s wife died in July and each year around this month he has erectile dysfunction problems.

“History repeats itself,” he said. “If there was the death of a father, you have to think what time of year it happened. If it happened around Nov. 16. Each year, you may have problems around Nov. 16.”

He added that stress is a major culprit with younger men, and younger people in general need to handle stress better in this faster-paced lifestyle.

“I can’t tell you how many times people come in and you hear all this tragedy in their life,” said Cohen. “Past generations have lived through a lot more. Now life is faster, but stresses are not greater. People have this perception of reality that everything is so stressful now and of course this can have a huge impact on one’s sexual health.”

Health-related factors that can cause sexual deficiencies, according to the American Urological Association, include:

— Nerve damage caused by longstanding diabetes (diabetic neuropathy)

— Cardiovascular disorders affecting the blood supply to the pelvis

— Certain prescription medications

— Operations for prostate cancer

— Fractures that injured the spinal cord

— Multiple sclerosis

— Hormonal disorders

— Alcoholism and drug abuse

Low testosterone is usually the culprit in men over 40-years-old and is usually accompanied by low sex drive, erectile dysfunction, osteoporosis or fracture, and two or more of the following: sleep disturbance, depressed mood, lethargy or diminished physical performance.

A recent study found that lack of sex drive and erectile dysfunction was a result of low testosterone levels, according to the New England Research Institute. The study, conducted on nearly 1,500 men in a community survey in the Boston area, examined participants ages 30- to 79-years-old.

Researchers found that one in four men older than 30 have low testosterone levels, and one out of every 20 has clinical symptoms linked to deficiency, according to the study.

Prevention and Coping

Medical professionals recommend lifestyle changes to help men prevent any bedroom problems. The Mayo Clinic recommends some preventative measures:

— Limit or avoid the use of alcohol and other similar drugs

— Stop smoking

— Exercise regularly

— Reduce stress

— Get enough sleep

— Deal with anxiety or depression

— See your doctor for regular checkups and medical screening tests

Lifestyle change not pills were recommended by most doctors as the best cure for most cases of erectile dysfunction, according to the John Hopkins study. The results showed that 18.4 percent of men over 20 suffered from erectile dysfunction, but the problem was more common in older men, with 70 percent of men 70 or older reporting erectile problems, compared with 5 percent of men 20- to 40-years-old.

Other findings include:

— Almost 90 percent of men with erectile dysfunction had at least one risk factor for heart disease, such as high blood pressure, elevated cholesterol, smoking, or diabetes.

— 50 percent of men with diabetes reported erectile dysfunction.

— Men with diabetes were three times more likely to have ED than men without diabetes, even after adjusting for other risk factors.

— Men who were physically inactive were much more likely to have ED than men who were physically active.

Cohen doesn’t recommend medication for erectile problems he believes are caused by something psychological.

“You can see pretty scary things with men who use Viagra like prolonged erections even after intercourse,” he said. “It’s not funny, especially at 2 in the morning. The guy is not happy, and the girlfriend is not happy either.”