ED usually has something physical behind it, particularly in older men. But psychological factors can be a factor in many cases of ED. Experts say stress, depression, poor self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.
Although few studies specifically evaluated the clinical characteristics of ED in younger men, this problem is increasingly frequent. Healthcare professionals both inside and outside of Sexual Medicine are likely to deal with young men complaining for ED and it is important that basic knowledge on this topic is available. In fact, young men reporting ED risk being dismissed without any specific medical assessment, including medical history or physical exam, owing to the assumption that ED in younger is a self-limiting condition, without any clinical consequence. However, evidence shows that, similar to middle-aged or older men, ED can be the consequence of the combination of organic, psychological and relational factors and all these components must be assessed for a correct clinical management. In particular, ED in younger, even more than in older men, can be considered a harbinger of CVD and it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.

Tadalafil should not be used with alpha-blockers (except Flomax), medicines used to treat high blood pressure, and benign prostate hypertrophy (BPH) because the combination of tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral), and prazosin (Minipress). Tamsulosin (Flomax) is the only alpha-blocker that patients can use safely with tadalafil. When tadalafil (20 mg) was given to healthy men taking 0.4 mg of Flomax daily, there was no significant decrease in blood pressure and so patients on this dose of tamsulosin (Flomax) can be prescribed tadalafil. The only alpha-blocker not tested with tadalafil is alfuzosin (Uroxatral), and no recommendations can be made regarding the interaction between the two.
Begot, I., Peixoto, T. C. A., Gonzaga, L. R. A., Bolzan, D. W., Papa, V., Carvalho, A. C. C., ... & Guizilini, S. (2015, March 1). A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction. The American Journal of Cardiology, 115(5), 5741-575. Retrieved from http://www.ajconline.org/article/S0002-9149(14)02270-X/abstract
Additionally, speaking to more than just the sexual issues related to erectile dysfunction, the research addresses implications related to the overall understanding of penile health. According to Arthur Burnett, M.D., a professor of urology and head of the research team, "eNOS plays roles in both immediate erectile response and the overall health and function of the penile tissue." 
Penile prosthesis is a viable option for men who cannot use sildenafil and who find the injections or vacuum erection therapy distasteful. A non-adjustable semi-rigid prosthesis is easy to insert and has no postoperative mechanical problems. The inflatable prosthesis has a pump that is put in the testicular sac for on-demand inflation and deflation. Future versions will have a remote control device similar to a garage-door opener.
The contents of your medicine cabinet could affect your performance in the bedroom. A long list of common drugs can cause ED, including certain blood pressure drugs, pain medications, and antidepressants. But do not stop taking any medicines without talking to your doctor first. Street drugs like amphetamines, cocaine, and marijuana can cause sexual problems in men, too.

Erectile dysfunction, often referred to as ED, is characterized by a persistent and recurring inability to achieve or maintain an erection sufficient for sexual intercourse. Psychological, physical and lifestyle issues can all cause ED, as can trauma to nerves and arteries. The incidence of erectile dysfunction increases with age, but young men can also experience it.
Erectile Dysfunction is usually a condition faced by men over the age of 50, but based on the large number of inquiries on blogs and forums from young men dealing with the symptoms of impotence and over 500 hits to my article  titled “Can Men in Their 20’s and 30’s Have Erectile Dysfunction,”  this demonstrates erectile dysfunction at all ages is a serious issue, and particularly erection problems in young men is a key issue these days. If you are in this age group and are dealing with erectile dysfunction, then you have come to the right place to learn about the issues of erectile dysfunction in young  men.
With that said, the only data we’re going to focus on here are the results of large, nationally representative sex surveys because they offer the best source of information when it comes to trying to establish realistic prevalence rates and how they might have changed over time. Data from convenience samples of college students just aren’t reliable enough for these purposes.
“Although having sex at 70 is not the same as having sex at 20, erectile dysfunction is not a normal part of aging,” according to Michael Feloney, MD, urologic surgeon and expert on sexual dysfunction issues at the Nebraska Medical Center in Omaha. “You should still be able to have a satisfying sex life as you age." If you are experiencing erectile dysfunction, these 10 dos and don'ts may help.
It was recommended that the patient focus on relaxation techniques, increase cardiovascular exercise, take cialis 5 mg PO prn as it is effective, and to start scheduled terazosin 1 mg po at bedtime to relax the hypertonic cavernous smooth muscle. It was recommended that he utilize lubricants for masturbation, that he decrease the frequency of masturbation, and that he investigate vibrators to increase glanular stimulation if necessary. It was also recommended that he stop using the various alternative therapies that he has been using for the past 6 months (topicals, lasers, electromagnetic therapies, hyperbaric oxygen), which were likely confounding the issue. At follow up, 4 weeks after the initial visit, the patient reported 60% improvement in his symptoms with seldom use of PDE5 inhibitors.
Carrying extra pounds can impact your sexual performance, and not just by lowering your self-esteem. Obese men have lower levels of the male hormone testosterone, which is important for sexual desire and producing an erection. Being overweight is also linked to high blood pressure and hardening of the arteries, which can reduce blood flow to the penis.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in all men and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:
That doesn’t mean you need to cut back completely — most experts say moderation is key. But what's “moderation” exactly? According to the U.S. Centers for Disease Control and Prevention (CDC), moderate drinking is no more than two drinks a day for men (and one drink a day for women). The liver can only break down the amount of alcohol in about one standard-size drink an hour, so regularly drinking more than that means that toxins from alcohol can build up in your body and affect your organs, including those involved in sex.
The time the dose should be taken and how long the effects last depend on the medication used. The most common side effect of these medications is a headache. However, there is a potential for certain dangerous drug interactions. Anyone prescribed this medication must let his doctor know about any medications he's on, and especially if he's taking nitrates (e.g., nitroglycerin spray, nitroglycerin pills, or nitroglycerin patch) for heart problems.
Erections also require neural input to redirect blood flow into the corpora cavernosae. Psychogenic erections secondary to sexual images or auditory stimuli relay sensual input to the spinal cord at T-11 to L-2. Neural impulses flow to the pelvic vascular bed, redirecting blood flow into the corpora cavernosae. Reflex erections secondary to tactile stimulus to the penis or genital area activate a reflex arc with sacral roots at S2 to S4. Nocturnal erections occur during rapid-eye-movement (REM) sleep and occur 3–4 times nightly. Depressed men rarely experience REM sleep and therefore do not have nocturnal or early-morning erections.

Chronic and persistent alcohol use is known to induce sexual dysfunction, which leads to marked distress and interpersonal difficulty. This, in turn, is known to worsen the alcohol abuse. Sexual dysfunction in the alcoholic may be due to the depressant effect of alcohol itself, alcohol-related disease or due to a multitude of psychological forces related to the alcohol use.[1] The spectrum of sexual dysfunction encompasses:
An erection involves the brain, nerves, hormones, muscles, and circulatory system. These systems work together to fill the erectile tissue in the penis with blood. A man with erectile dysfunction (ED) has trouble getting or maintaining an erection for sexual intercourse. Some men with ED are completely unable to get an erection. Others have trouble maintaining an erection for more than a short time.
The most common diagnostic test for erectile dysfunction is called penile ultrasound. This test uses sound waves to look for abnormal penile blood supply. Another test that may be done is nocturnal penile tumescence testing, in which a type of computer is attached to the penis to see if nighttime erections are occurring. If a young man is having nighttime erections but can’t get an erection during sex, a psychological cause becomes more likely.

Total testosterone levels: Health care professionals should obtain a patient's blood samples for total testosterone levels in the early morning (before 8 a.m.) because the testosterone levels go up and down throughout the day. If you have a low testosterone level, a health care professional should check it again to confirm that it is truly low. In some men, a specialized test measuring the active form of testosterone (free or bioavailable testosterone) may be recommended.


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A medical history focused on risk factors, such as cigarette smoking, hypertension, alcoholism, drug abuse, trauma, and endocrine problems including hypothyroidism, low testosterone levels, and hyperprolactinemia, is very important. Commonly used drugs that disrupt male sexual function are spironolactone (Aldactone), sympathetic blockers such as clonidine (Catapres), guanethidine (Islemin), methyldopa (Aldomet), thiazide diuretics, most antidepressants, ketoconazole (Nizoral), cimetidine (Tagamet), alcohol, methadone, heroin, and cocaine. Finally, assessment of psychiatric history will help identify emotional issues such as interpersonal conflict, performance anxiety, depression, or anxiety.
ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.
Alcohol use.  Excessive drinking of alcohol and binge drinking among young men, especially between the ages of 22 and 30, can lead to ED.  I did my share of drinking in college, and found it was difficult to perform while intoxicated.  Mild or moderate alcohol use can result in temporary impotence, and erections will return once the alcohol is out of your system.  But, when drinking becomes excessive, it is believed that alcohol acts as a sedative on the central nervous system, thus depressing the male libido and sexual desire, which in turn inhibits the brain from sending signals to the heart to pump blood to the penis.  A lack of blood flow to the penis prevents your ability to maintain or achieve an erection.

There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, says Ira Sharlip, MD, a urology professor at the University of California San Francisco School of Medicine. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
With that said, the only data we’re going to focus on here are the results of large, nationally representative sex surveys because they offer the best source of information when it comes to trying to establish realistic prevalence rates and how they might have changed over time. Data from convenience samples of college students just aren’t reliable enough for these purposes.

Association between metabolic syndrome (MetS) at baseline and incidence of major adverse cardiovascular events (MACE) during a mean follow-up of 4.3 years. Panel A represents the Kaplan Meier curves for incidence of MACE in a population of 211 men aged 18–52 years having or not MetS at baseline. This group represents the first tertile of age of a sample of patients (n=619) consulting the Sexual Medicine and Andrology Unit of the University of Florence for erectile dysfunction and followed-up for a mean of 4.3 years for the occurrence of MACE. Panel B represents the Cox analyses for the age- and smoking habit-adjusted incidence of MACE associated with the number of MetS components at baseline (glycaemia ≥100 mg/dL, triglycerides ≥150 mg/dL, HDL <40 mg/dL; blood pressure ≥135/80 mmHg, waist circumference >102 cm), according to the tertile of age, in the same population, during the same follow-up. The first, second and third tertile include 211, 199 and 209 patients aged 18–52, 53–60 and 61–88 years, respectively.
Surgery to repair arteries (penile arterial reconstructive surgery) can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.
Men with diabetes are at a higher risk of erectile dysfunction or impotence, especially if their diabetes is not well controlled. Erectile dysfunction means you cannot have an erection that is sufficient to perform sexual intercourse. Many men experience short-term episodes of erectile dysfunction but, for about one in 10 men, the problem may continue.
Penile prostheses are very effective, and most patients who have a prosthesis placed are satisfied with the prosthesis. However, placement of a prosthesis causes scarring of the tissue within the corpora cavernosa, and if the prosthesis requires removal, other forms of therapy, except for the vacuum device, are often not effective. Thus, most physicians reserve placement of a prosthesis for men who have tried and failed or have contraindications to other therapies.
Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.

Alcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction.[3] Episodic erectile failure in alcoholic men is fairly routine, found to be significantly higher in men consuming more than three standard units of alcohol (12 g ethanol) daily and in subjects smoking more than 10 cigarettes/day.[4] Van Thiel and Lester[5] reported that 61% of patients dependent on alcohol reported sexual dysfunction, the most common being erectile dysfunction followed by reduced sexual desire. Erectile dysfunction and reduced sexual desire were frequently seen to be coexisting.[6–9] Vijayasenan,[10] found that of 97 male inpatients admitted for the treatment of alcoholism, 71% suffered from sexual dysfunction for a period of more than 12 months prior to admission to a hospital. The disturbances noted were diminished sexual desire (58%), ejaculatory incompetence (22%), erectile impotence (16%) and premature ejaculation (4%). Virtually all aspects of the human sexual response are affected by alcohol especially sexual desire and erection.[11]
While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Drugs approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra. The pellet can trigger an erection within 10 minutes.
Psychological causes are less common than we thought but more often the cause in younger men. Performance anxiety triggers the release of adrenaline. Adrenaline causes blood to flow TO the vital organs, such as the heart, lungs and brain, and AWAY from less vital structures like the fingers, toes and the penis. Our bodies do this to cope with the physical stress of a physical attack or physical challenge, but sexual anxiety also triggers this reflex.

While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Drugs approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra. The pellet can trigger an erection within 10 minutes.
Professor Michael Holmes, of the Nuffield Department of Population Health at the University of Oxford, one of the study’s lead authors, said: “Our finding is important as diabetes is preventable and indeed one can now achieve ‘remission’ from diabetes with weight loss, as illustrated in recent clinical trials. This goes beyond finding a genetic link to erectile dysfunction to a message that is of widespread relevance to the general public, especially considering the burgeoning prevalence of diabetes.”
Our team includes a sex advisor/counselor who can help you understand what is making you anxious around sex, and give you techniques to decrease your anxiety about sex. He has also helped many of our younger patients get better at sex. We also have an exercise physiologist, who will work with you on both diet and exercise, which can have a profound effect on the quality of your erections.
Now, there are lots of ways that you can reduce stress and anxiety in your life. One of those things you can do is exercising daily. Now, it doesn’t mean getting into a gym all the time, but it can just be doing sit-ups at home, long walks at the grocery store, bicycling, and if you can afford the gym, getting there maybe two to three days a week. But don’t forget, a healthy body equals a healthy mind. Meditation, yoga, breathing exercises– now, here’s where you can take a few moments to be centered and communicate with your inner self, peace. Healthy eating– now, taking control of the intake of what goes into your body makes you to start feeling better and looking better. That wellness is the opposite of anxiety. And treating issues and tackling things that are weighing you down, taking that very first step is liberating.
Then you have to be able to make the right diagnosis. What is the basis for their erectile dysfunction? Is it psychogenic? Is it some sort of neurological or blood vessel or hormonal issue? So you have to make a diagnosis. You have to be able to make an assessment. And then only after those things are done, then you start to think about medications.

In the short term, alcohol relaxes muscles in the penis, letting blood to flow in (which is a good thing). However, alcohol also prevents other blood vessels from closing and trapping all the extra blood. Erections depend on trapping increased blood flow in the erectile tissue of the penis. If you don’t trap that extra blood, you don’t get an erection. In the long run, excessive alcohol consumption can cause liver scarring, high blood pressure, and can damage your blood vessels resulting in erectile dysfunction.


Although ED can become a permanent condition, this typically isn’t the case for men who experience occasional erectile difficulties. If you have diabetes, you may still be able to overcome ED through a lifestyle that includes sufficient sleep, no smoking, and stress reduction. ED medications are usually well-tolerated, and can be used for many years to help overcome any ED problems.
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