By Deborah Jeanne Sergeant
Historically, erectile dysfunction represents a health issue that most men older than 45 face to an extent.
But in recent years, the number of cases of ED in younger men has increased.
According to the multinational Men’s Attitudes to Life Events and Sexuality (MALES) study published by the National Institutes of Health, about 8% of men aged 20-29 and 11% of men 30-39 have ED.
“The Massachusetts Male Ageing Study determined that at approximately 20 years of age, 20% of men will complain of some form of ED — but this covers mild, moderate and severe [cases]. At 30 years of age, it is 30%, and so on.”
Compared with previous cohorts, more young men are contacting a healthcare provider to treat their ED, according to several studies.
But does this mean that more have ED or that they feel more comfortable presenting with ED at their doctor’s office than the previous generation?
Physician Pebble Kranz, sexual medicine specialist with Rochester Center for Sexual Wellness, thinks that both could be factors, but a higher comfort level is likely the primary reason for the uptick.
“I see a lot of people, a lot of young men with ED,” Kranz said. “There are a lot of factors that can contribute.”
She listed performance anxiety as a major factor, as this can raise adrenaline which can restrict blood flow to the penis.
“It is impossible to have an erection in that state,” Kranz said.
Before taking other approaches, she encourages patients to address performance anxiety and general stress first. Unfortunately, stress is commonplace among young men.
Kranz said that certain medications can also contribute to ED such as some of those affecting mood. Since 2020, there’s been an increase in use of these drugs among young adults — as high as a 63.3% jump, according to the American Academy of Pediatrics, which looked at youth aged 12-25. The young men in that cohort are trying to pay off college debt, launch a career and find affordable housing (or staying with Mom and Dad).
“There’s extra stress compared with how it’s been in the past,” Kranz said. “I also have to wonder about cardiovascular risk factors in younger people because ED is an important marker of cardiovascular disease, particularly when it occurs in a younger person. If there’s a greater prevalence of things that are causing cardiovascular risk, that may be a contributor as well.”
She explained that the blood vessels in the penis are one to two millimeters in diameter, compared with coronary arteries, which are three to four millimeters and carotid arteries, which are five to seven millimeters. This means that ED in young men can indicate heart disease is present also. Numerous studies report that cardiovascular disease is increasing among young adults because of poor diet, unmanaged stress and lack of exercise.
Physician Ryan Sidebottom, urologist with Auburn Community Hospital, also views ED as a multifaceted issue. In addition to greater reporting and the psychological components affecting young men, Sidebottom noted that “we’re seeing more early onset diabetes, metabolic syndrome and obesity. It can affect vascular health and hormonal health and that can affect erections.”
He said that essential to any exam involved ED is a general medical history, medication review, lab work and addressing any metabolic issues. For example, men who are diabetic need to address weight and control their blood sugar levels. Those with low testosterone may seek replacement therapy. Smoking cessation can help increase blood flow throughout the body.
For many men, using medication can help achieve better erections. Sidebottom noted that phosphodiesterase inhibitors (PDE 5) help by stimulating the nerve going to the penis to increase blood flow and with dilation of the penis.
“If this fails, there are further options for ED,” Sidebottom said. “There are injections that can go into the blood vessels to the penis. There are tablets that can be placed in the urethra that can cause dilation into the penis. And vacuum pumps. They can help draw venous blood into the penis. And surgical interventions with penile prostheses. It replaces the chambers that fill with blood with chambers attached to a pump to fill the balloons to fill with water as desired. There is a very high satisfaction rates. It’s a big step and a last step in the process. But it does work very well.”