In most young men with ED, additional testing to assess for the origin of ED is unnecessary as the history gives you the information that you need. With this said, it may be therapeutic for the patient to know his laboratory assessments are normal, in which case additional testing does add significant value to the assessment. From the history alone, we find that most of these men will have situational erectile dysfunction that responds well to low dose oral PDE-5 inhibitors. If the patient does respond well to these medications, the diagnosis of neurogenic erectile dysfunction, clinically significant arterial insufficiency, or venous-occlusive dysfunction can efficiently be ruled out. If the patient responds inconsistently or does not respond to the oral medications, additional workup should be considered, dependent on the additional history provided.
Psychological Causes of ED – Between 10% and 20% of ED cases have a psychological cause. Because arousal starts in the brain, psychological issues can be a significant contributing factor to erectile dysfunction. Mental health conditions like depression or anxiety can negatively impact your libido, making it more difficult for you to become aroused.
L-arginine is an amino acid that occurs naturally in the human body and helps make that magic nitric oxide so important for supporting an erection. A 1999 study observed the effects of six weeks of L-arginine administered daily among men with ED. One third of those who took five grams per day of L-arginine experienced significant improvements in sexual function.

The first goal in treating ED is to manage your diabetes. This includes keeping your blood sugar and blood pressure under control. If ED persists, treatments are available. While oral medications are a common first therapy, they don’t work for all men with diabetes. The penile implant may be an option. The implant is concealed inside the body. It offers support for an erection whenever and wherever desired.
Depression. The profound sadness, emptiness, and hopelessness that characterize depression may also cause ED among younger men. “The biggest effect of depression is on a man’s desire for sexual relations, or libido,” says Drogo Montague, MD, director of the Center for Genitourinary Reconstruction in the Glickman Urological and Kidney Institute at the Cleveland Clinic. “To some extent, depression can affect a man’s ability to maintain an erection. It can be a chicken-and-egg situation. However, reduced libido is a common indicator of depression.”
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.

Although ED and diabetes are two separate conditions, they tend to go hand in hand. Half of men with diabetes will experience ED within 10 years of their diagnosis.8 For some men, ED may be the first symptom of diabetes even if they have not yet been diagnosed, particularly in men younger than 45.6 Left untreated, ED can damage self-confidence and relationships.
Nevertheless, this study highlights the ubiquitousness of sexual problems in the heavy-drinking population. It also stresses the need for addiction medicine specialists to note the possibility of sexual problems in their clients. In addition, it highlights the need for sexual medicine specialists to consider the effects of heavy alcohol use on sexual functioning. However, there is ample evidence that alcohol-induced sexual dysfunction, for the most part, is reversible with cessation of alcohol use.[18] Thus, this information can be used in motivational counselling of heavy drinkers to provide impetus for change. Clinicians are well advised to routinely assess sexual functioning in patients with alcohol dependence.
Counselling or sex therapy (58% of people find this works for them) –mind-related causes of erectile dysfunction can affect anyone. They are more likely if you experience erectile dysfunction at a younger age. Talking to a counsellor or therapist can help some people overcome erectile dysfunction related to these problems, possibly for good. They can also help you if your erectile dysfunction is causing you stress, as this can make matters worse.
All three of these involve specific bodily systems including the hormones, muscles, blood vessels, nervous system, and emotions. If any of these systems become compromised, it can cause ED. In the case of anxiety and stress, these things can affect the brain’s ability to send the necessary signals to trigger the desired physical response – an erection. Stress and anxiety can also contribute to an ongoing cycle of ED, as mentioned earlier.
Alprostadil should not be used in men with urethral stricture (scarring and narrowing of the tube that urine and the ejaculate pass through), balanitis (inflammation/infection of the glans [tip] of the penis, severe hypospadias (a condition where the opening of the urethra is not at the tip of the penis, rather on the underside of the penis), penile curvature (abnormal bend to the penis), and urethritis (inflammation/infection of the urethra).
Erections are neurovascular events, meaning that nerves and blood vessels (arteries and veins) are involved in the process of an erection and all must work properly to develop a hard erection that lasts long enough. Erection begins with sexual stimulation. Sexual stimulation can be tactile (for example, by a partner touching the penis or by masturbation) or mental (for example, by having sexual fantasies, viewing porn). Sexual stimulation or sexual arousal causes the nerves going to the penis to release a chemical, nitric oxide. Nitric oxide increases the production of another chemical, cyclic GMP (cGMP), in the muscle of the corpora cavernosa. The cGMP causes the muscles of the corpora cavernosa to relax, and this allows more blood to flow into the penis. The incoming blood fills the corpora cavernosa, making the penis expand.
Think of erectile dysfunction as your body’s “check engine light.” The blood vessels in the penis are smaller than other parts of the body, so underlying conditions like blocked arteries, heart disease, or high blood pressure usually show up as ED before something more serious like a heart attack or stroke. ED is your body’s way of saying, “Something is wrong.” And the list of things that cause erectile dysfunction can include:
Normal male sexual function requires a complex interaction of vascular, neurological, hormonal, and psychological systems. The initial obligatory event is acquisition and maintenance of an erect penis, which is a vascular phenomenon. Normal erections require blood flow into the corpora cavernosae and corpus spongiosum. As the blood accelerates, the pressure within the intracavernosal space increases dramatically to choke off penile venous outflow. This combination of increased intracavernosal blood flow and reduced venous outflow allows a man to acquire and maintain a firm erection.

Failure to achieve an erection is not uncommon for most men and may be considered normal even if it happens as often as 20 percent of the time. There is a wide range of normal when it comes to sexual functioning and sexual relationships. "Generally if a couple feels comfortable with their sex life and they enjoy intimacy together, erectile dysfunction may not be much of an issue. But if erectile dysfunction is causing stress in a relationship, then help is available," says Feloney.
And be aware that the vast majority of physical or psychological causes of erectile dysfunction are temporary. They may go away as quickly as they occurred. But if anything is bothering you or your partner, you should seek out confidential, professional advice. There is no point in worrying and not doing anything about it. It may just make the situation worse.
The common PDE5 inhibitor drugs approved in the United States are sildenafil (Viagra), vardenafil (Levitra and Staxyn, the generic form), tadalafil (Cialis), or avanafil (Stendra). All of the currently approved PDE5 inhibitors work in the same way. They differ in the number of available doses, how quickly they work and last in your system, the dosing, and to some extent in the side effects. However, they generally share the same indications and contraindications. Currently, tadalafil is the only medication that patients can take on a daily basis and is approved for the treatment of both ED and BPH (benign enlargement of the prostate).
Diabetes is a serious disease requiring professional medical attention. The information and recipes on this site, although as accurate and timely as feasibly possible, should not be considered as medical advice, nor as a substitute for the same. All recipes and menus are provided with the implied understanding that directions for exchange sizes will be strictly adhered to, and that blood glucose levels can be affected by not following individualized dietary guidelines as directed by your physician and/or healthcare team.
Few men want to talk about their inability to get or maintain an erection, however, erectile dysfunction can have a profound impact on relationships and self-esteem. Fortunately, trouble in the bedroom doesn't necessarily mean you're dealing with erectile dysfunction. Most men will have problems with an erection at some point in their sexual history. But one bad day in the bedroom doesn't mean major sexual health problems. So how can you know if you're dealing with erectile dysfunction?
Erectile Dysfunction is typically caused by a problem with blood flow in the penis due to the hardening and narrowing of the blood vessels of the penis. This occurs most commonly due to aging itself, which causes the smooth muscle cells that line the blood vessels to become stiffer and less able to stretch. This prevents the flow of blood that the penis requires to become erect.

“Sex often feels different for your partner when you experience ED,” warns Dr. Schwarts. “Men may not notice gradual changes to the girth or angle of his erection. But his partner does.” If you or your partner notice a persistent change in your erections that affects your sexual intimacy, you may have erectile dysfunction—even if you’re still able to get an erection.


Other medical therapies under evaluation include ROCK inhibitors and soluble guanyl cyclase activators. Melanocortin receptor agonists are a new set of medications being developed in the field of erectile dysfunction. Their action is on the nervous system rather than the vascular system. PT-141 is a nasal preparation that appears to be effective alone or in combination with PDE5 inhibitors. The main side effects include flushing and nausea. These drugs are currently not approved for commercial use.
Accurate statistics are lacking on how many men are affected by the condition because it is often underreported, but it is estimated that about half of men over 40 in Canada have frequent problems achieving or maintaining an erection. The number of men suffering from erectile dysfunction increases with age, but it is not considered a normal part of aging. The majority of cases can be successfully treated.

Describing the epidemiology of ED in young men requires, first of all, defining what it is meant by youth. While the definition of old age is matter of discussion and a precise threshold does not exist, the most shared definition in Western Countries is age above 65 years (http://www.who.int/healthinfo/survey/ageingdefnolder/en/). Considering that most of the epidemiological studies on general populations aimed at studying health changes with age, enrol men more than 40 years, it seems reasonable to define young age as below 40 years. Epidemiological studies on erectile function, which considered the prevalence of ED according to age bands, consistently find a significant increase with ageing. Advancing age remains one of the most important unmodifiable risk factors for ED (1). Studies on ED mostly involve middle-aged and older men, with younger aged men often overlooked. In a multi-centre worldwide study, involving more than 27,000 men from eight countries, Rosen et al. (2) showed an ED prevalence of 8% among men aged 20–29 years and 11% among those aged 30–39 years. Most of the studies involving younger men and conducting age-stratified analyses have been performed in Europe, where the prevalence of ED in men younger than 40 years ranges between 1% to 10% (3-10). The prevalence reported in these studies is highly variable due to different methodologies used in defining ED, population accrual, acquisition of data and choice of tools for investigating erectile function. A smaller number of studies on this topic have been conducted outside Europe. Both in Australia (11,12) and in America (13-15), the available information suggests a similar range of prevalence of ED among young subjects, with the same extent of variability among studies. According to these data, ED in younger men, although still not extensively studied and largely overlooked by the scientific community, is a quite common condition. In a recent study conducted in a Urology Clinic, it has been observed that one out of four men seeking medical care for ED was younger than 40 years (16). In our Sexual Medicine and Andrology Unit, established in an Endocrinology setting at the University of Florence, medical consultations for younger men are infrequent, with a prevalence of men aged less than 40 years at only 14.1% of more than 3,000 men complaining of ED. However, when considering the new referrals to our Unit during the last 6 years, we can notice a progressive increase in prevalence of men below 40 years seeking medical care for ED (Figure 1). According to these data, ED is becoming a common concern even among young men, and the clinical practitioner in sexual medicine must become aware of how to manage the problem and avoid underestimating a symptom. The identification of ED in a young man may potentially provide a great deal of useful information that can help improve their quality and even length of life.
ED may occur with or without other sexual dysfunction, including decreased libido (decreased interest in sexual activity), orgasmic dysfunction (troubles achieving an orgasm/climax), and ejaculatory dysfunction (problems with the fluid released during sex, including lack of ejaculation [anejaculation], small volume ejaculate, ejaculation that occurs too quickly [premature ejaculation], ejaculate that goes backward into the bladder [retrograde ejaculation] and pain with ejaculation).
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

When these drugs don't work, there are other options. Medications that dilate blood vessels, such as alprostadil, can be injected or deposited in the penis; they work in more than 80 percent of men with diabetes. Beyond that, penile implants can be an effective surgical solution. Implants are either malleable rods, which can be manually adjusted to the desired position, or inflatable cylinders that fill with fluid when a pump under the skin of the scrotum is pressed.
The penis is composed of three cylinders: two on the top, the corpora cavernosa and one on the bottom, the corpus spongiosum. All of these are involved in the process of an erection. The corpora cavernosa are composed of potential spaces that can distend with blood, causing rigidity of the penile shaft. The corpus spongiosum is important for rigidity of the glans of the penis. When aroused, stimulated chemicals are released from the nervous system (nitric oxide is one) that stimulate the arteries to the penis to relax and increase blood flow into the penis. These potential spaces, like a sponge, can expand when more blood flow comes in the penis. Each corpora cavernosa is surrounded by an outer coating the tunica albuginea. When the penis fills with blood, these potential spaces, the sinusoids, compress the veins in the corpora against the side of the tunica albuginea, thus preventing blood from leaving the penis. It is this compression of the veins that allows for the erection to become fully rigid.
This man’s history is adequate to rule out arterial or venous insufficiency as he can masturbate to produce a rigid, sustainable erection and he responds well to tadalafil. Due to his report of gradual onset, his lack of response to ongoing sexual therapy, and his tremendous anxiety associated with the issue, the decision was made to offer a PCDU to assess for a vascular etiology for his disorder. PCDU revealed normal peak flow bilaterally of 40 cm/sec with no end diastolic flow and 100% rigidity obtained. His erection lasted more than 2 hours and required phenylephrine to resolve the erection.
If you are experiencing ED, you should talk with your doctor about your potential risk for cardiovascular disease. And if you’re already taking certain medications such as nitrites for your heart or alpha-blockers to manage blood pressure, your doctor will discuss whether ED medications are right for you or whether other options may be more appropriate.

Few men want to talk about their inability to get or maintain an erection, however, erectile dysfunction can have a profound impact on relationships and self-esteem. Fortunately, trouble in the bedroom doesn't necessarily mean you're dealing with erectile dysfunction. Most men will have problems with an erection at some point in their sexual history. But one bad day in the bedroom doesn't mean major sexual health problems. So how can you know if you're dealing with erectile dysfunction?
Intermountain Healthcare is a Utah-based, not-for-profit system of 23 hospitals, a Medical Group with more than 1,600 physicians and advanced practice clinicians at about 180 clinics, a health plans division called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and in efficient healthcare delivery.
What has been excluded entirely from all recent discussions of ED in young men is a concept presented many years ago—the concept of increased sympathetic tone as an organic etiology of “psychogenic” erectile dysfunction in young men (5). Previous studies have shown that elevated central sympathetic tone may be one cause of impotence (6,7). This article focuses on the presentation, work-up, and treatment of young men (age: 16–35 years old) with complaints of ED, and we will attempt to present a new method of approaching these patients. It is important to identify the precise etiology of ED in these men before proceeding with potentially unnecessary evaluation and treatment as the process can be anxiety-provoking, invasive, and costly and may provide an unreliable diagnosis which produces further psychological distress in these psychologically fragile young men.
Diabetes, high blood pressure (hypertension), elevations in blood lipids or cholesterol are considered blood vessel problems and have all been associated with Erectile Dysfunction. The blood vessel abnormalities caused by these diseases affect vessels throughout the body and often produce other symptoms of vascular diseases. Diabetics and patients with hypertension frequently have heart disease. These conditions typically interfere with the ability of the penile vessels to work properly and ultimately cause ED.
No matter what the cause of erectile dysfunction, it is likely to cause feelings of stress and other emotional reactions. It’s also not uncommon for erection problems to cause tension in a relationship, particularly if one or both partners withdraws emotionally and the problem is not talked about. And it’s possible for a man’s renewed ability to have intercourse after a period of no sexual activity to stir up relationship issues.
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