Stress, performance anxiety or even medications like antidepressants can affect a young man's erection. Over the past decade, doctor's reports of young adults and adolescents with ED have increased rapidly, with one practice reporting a 31 times increase in young patients aged 14 to 21 presenting with ED. Now, one in four men under 40 are believed to experience ED today.
"I think awareness is probably the biggest thing, to know that, you know, you're not alone in it," said Dr. Thomas M. Buckley, associate professor of urology at the School of Medicine. "It's something that is treatable, it is something you should see a healthcare provider about."
ED typically stems from two broad causes: psychogenic, meaning issues related to mental health or performance anxiety, or organic, where ED stems from physical medical disorders.
A quarter of men are believed to be affected by performance anxiety, where anxiety about sex or sexual performance leads to erectile dysfunction. Dr. Stanton Honig, Yale professor of urology, explained that anxiety causes the body to release adrenaline. This decreases blood flow to the penis, meaning blood cannot be "trapped" there, leading to the penis being unable to become or remain erect.
When anxiety is reduced, "the problem resolves itself in many cases," according to Honig.
Sometimes ED can be caused by anxiety stemming from mental health disorders. However, the medication that treats conditions such as anxiety and depression can also contribute to ED.
"It's kind of a double-edged sword, in the sense that anxiety and depression can cause erectile dysfunction, but their medications can also cause erectile dysfunction," Buckley said. "So you're kind of caught in this vicious cycle."
Lifestyle choices can also lead to ED in young men.
For example, junk food, high alcohol consumption and cannabis smoking are all linked to erectile dysfunction. Researchers have also linked higher rates of ED to men who started watching pornography at a younger age. Social media pressure, pornography and unrealistic expectations can create anxiety among young men, Honig explained.
Rising levels of ED could also be the lasting effect of the COVID-19 pandemic. Isolation, worsening mental health and even COVID-19 infection itself can all be factors relating to ED.
How can erectile dysfunction be treated?
Alongside lifestyle changes, medications like Viagra and Cialis in low dosages can be used to help men overcome erectile dysfunction, including cases related to anxiety. According to Dr. Matthew Wosnitzer, a urologist at Yale New Haven Health, ED medications do not create reliance or tolerance.
Aside from medication, there are also over-the-counter treatments such as Eroxon, a topical gel made to aid erectile dysfunction. However, Buckley stresses that there are "actual effective medications delivered to your doorstep without ever seeing a doctor," stating that these types of gels are not worth the hype.
Additionally, Honig explained that holding realistic expectations about sex or therapy can also help those with ED.
Honig, alongside Yale urologist Dr. Katherine Rotker, has compiled a list of potential beneficial actions and supplements for those with erectile dysfunction. This includes not resting laptops on one's lap for long periods of time, avoiding excessive exercise and eating a balanced diet.
Finally, reducing stigma around ED by understanding its causes and effects can be beneficial to men with this condition as "men's sexuality is tied into a lot of their self-esteem," Buckley explained.
By encouraging young men to see a doctor about ED, not only can sexual dissatisfaction be improved, but certain medical conditions could be spotted early, according to Wosnitzer.