Erectile dysfunction (ED) is likely the most difficult and sensitive topic a male patient will have to discuss with their doctor, especially for a patient in their 20s and 30s. The overall societal stigma and awkwardness placed on this condition can lower one’s self esteem and become a barrier to starting this conversation.
Many young men with ED may feel it is impossible for someone their age to have these symptoms. However, approximately 20% of men in their 20s and 30% of men in the 30s suffer from at least mild to moderate symptoms of ED.
Fortunately, as primary care physicians, we are fully prepared to have this discussion with our male patients and thoroughly investigate all medical/physical and psychological/emotional causes. Patients at City Care Family Practice can schedule an appointment anytime to discuss their symptoms, or at the very least, bring it up during a yearly physical. The key is for our patients to feel comfortable broaching this topic with their doctor. Hopefully, the information presented in this article will help do just that.
The three components of male sexual function are:
- Interest and desire for sexual activity (libido)
- The ability to obtain and maintain an erection
- The ability to ejaculate and climax (orgasm)
The most common form of ED and what we primarily encounter at City Care Family Practice is number 2, the inability to either get an erection at all, or to sustain an erection that will be firm and large enough and last through ejaculation. Less common problems like low sex drive and premature ejaculation can also be discussed with us.
During our initial evaluation of ED, we will always explore and rule out the medical causes of these symptoms first. Common medical or physical causes usually unique to older men (over the age of 40) include diabetes, cardiovascular and kidney disease, high blood pressure, high cholesterol, and low testosterone. For these causes, treatment for ED is geared towards directly treating these medical conditions first.
For men in their 20s and 30s, common medical or physical causes include obesity, alcohol use, cigarette smoking, medication side effects, neurological disease, Peyronie’s disease (abnormal curvature of the penis) and penile injury. Based on this medical evaluation, we can then help you formulate a plan to treat your ED symptoms by focusing on better lifestyle habits.
Ultimately, for men in their 20s and 30s, ED symptoms are most commonly due to psychological or emotional causes which manifest as performance anxiety. As mentioned earlier, the most common form of ED is obtaining and maintaining an erection, and this usually presents when having either oral, vaginal, and/or anal intercourse with another person, and may not present with self-masturbation. This is usually an initial clue that the primary cause of these symptoms is psychological/emotional.
Performance anxiety during sex can be mainly attributed to having a new partner, an increase in common life stressors, and undiagnosed and/or untreated anxiety and depression. The physicians at City Care Family Practice can help start your treatment for anxiety and/or depression. Developing proper coping mechanisms, using friends and family support systems, seeing a therapist, and taking medication can help remedy these conditions and ultimately treat ED.
Additional ways we can help treat ED symptoms include discussing in detail your self-masturbation and pornography watching habits and going over proper Kegel exercises. There are also medications (such as Viagra and Cialis) that we can prescribe if needed to treat ED symptoms. Other forms of treatment (recommended to be done under the supervision of a urologist) include testosterone replacement therapy, using vacuum erection devices, and penile implants.
With patience in finding the treatment that works for you, we can help you overcome the hurdles that erectile dysfunction brings to your sex life.