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What to Know About Erectile Dysfunction In Younger Men
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Erectile dysfunction (ED) is a condition that is commonly associated with older age, but the inability to get or maintain an erection can also affect younger men—even teens.
ED is more common in men under the age of 40 than you might think, though the causes of ED in younger men are often different than in older men.
In most cases, ED is treatable, but the condition can be a sign of an underlying health condition, such as early heart disease . 1 If you're experiencing ED at any age, but especially if you are in your teens or 20s, it's important to talk to your doctor. 2
Here's what you should know about ED in younger men, including the possible causes and ways to treat the condition.
Erectile dysfunction (ED) is a condition that typically affects people with a penis who are over the age of 40. 3 By the time a person is in their 40s, they will have a roughly 40% chance of having some form of ED—whether mild, moderate, or severe. For every decade thereafter, the risk increases by 10%. 4
While the risk of ED has been linked to older age, men under age 40 are also affected. A 2013 study that was published in the Journal of Sexual Medicine found that 26% of cases of ED—roughly one in four—occur in people ages 40 and under. 5
The study also noted that younger men who sought treatment were more likely to have severe ED than men over the age of 40 (48.8% vs. 40%). 5
While this could simply mean that younger men are more reluctant to seek treatment, the factors contributing to ED in this group of men were different. Overall, younger men with ED have a lower body mass index (BMI) , higher testosterone count , and fewer comorbid medical conditions than their older counterparts. On the other hand, they had higher rates of smoking and illicit drug use, both of which are known risk factors for ED. 5
Other studies have suggested that around 8% of men between the ages of 20 and 29 and 11% of males ages 30–39 have some form of ED. 6 The actual number might be even higher because men under the age of 40 are less likely to seek treatment than those over the age of 40. 7
According to the Centers for Disease Control and Prevention (CDC), around 30 million men in the United States—roughly one in five—have some form of erectile dysfunction. 8
An erection is a complex physiological response involving the brain, hormones, nerves, muscles, and the circulatory system. Breakdown in any of these systems can lead to ED. In most cases, more than one factor is involved. 9
In addition to physiological (organic) causes, there are also psychological (psychogenic) causes—some of which play a central role in the onset of ED. Although ED in younger men was once thought to be almost exclusively psychogenic, more recent research suggests that 15%–72% of ED cases involve a wholly organic cause. 10
Organic causes of ED include any condition that affects the physiological ability to achieve or sustain an erection.
In younger men, the causes can be broadly categorized as involving hormones (endocrinologic), involving the nervous system (neurologic), or involving blood vessels (ad vasculogenic). Medication side effects are also included because they can directly influence hormone levels. 2
In men under 40, organic causes of ED include: 2
In men under the age of 40, smoking and recreational drug use are consistently found to be key risk factors for the development of ED. While heavy alcohol use can also cause sexual dysfunction, its relation to ED in younger men is uncertain. 10
Emotions and moods also play an important role in the ability to achieve an erection because of how they relate to nerves, hormones, and the circulatory system. There are two aspects of an erection: the reflex erection, which is influenced by touch, and the psychogenic erection , which is influenced by emotions and erotic stimuli. 11
Some negative emotions and moods can diminish the ability to get or keep an erection. On rare occasions, they can even be the sole cause of ED. Even if the primary cause of ED is physical, the emotional stress that a person is experiencing can make the condition worse.
The psychogenic causes of ED can affect men of any age, but younger men might be more affected because they are often expected to be more "virile" and have greater "sexual prowess." 11
Common psychogenic causes of ED include: 12
Erectile dysfunction is closely linked to aging, in part because older men often have conditions like hypertension, heart disease, and diabetes. Doctors will often take a more extensive approach when diagnosing ED in younger men.
In addition to a physical exam, a doctor will review your medical and family history to check for any risk factors that you may have. They will also ask you about any drugs that you take, including whether they are prescription, over-the-counter (OTC), or recreational. 12
The doctor will also ask specific questions about your condition, including when the problem started, how severe it is, and what is going on in your life. These questions will help them figure out whether the primary cause is likely to be organic or psychogenic.
The abrupt onset of ED or intermittent episodes of ED are suggestive of a psychogenic cause, while the gradual onset of ED or constant ED is more indicative of an organic cause. 12
There are also some other tests and procedures that a doctor might use to diagnose ED, including: 12
If the cause is thought to be psychogenic, your doctor might refer you to a psychologist. You can talk with this expert about any sexual, relationship, or mental health factors that might be contributing to your ED. Anxiety reduction using alternative measures or working with a therapist, psychologist, psychiatrist, or couple's counselor, may also be helpful.
The ED treatments that are often used in older people can also be tried in younger people, but the treatment that will work best will vary from person to person. A combination of lifestyle changes, counseling, medications, and other therapeutic approaches is usually tried first.
Your doctor will also treat any underlying medical conditions or address current treatments for conditions that could be contributing. For example, you might be able to change a medication that is causing ED.
Research has not shown that being overweight or obese is inherently linked to ED in younger men, partly because their stronger cardiovascular systems tend to compensate. 10 However, obesity can reduce testosterone levels in some men and further complicate ED symptoms. 6
There are some simple lifestyle changes that may help improve the quality of your erections as well as improve your overall health and well-being, including:
Viagra (sildenafil) is one of the best-known medications for treating ED, but it's not the only prescription drug that can be used to treat this condition.
There are several oral and injectable drugs that can either be used on demand or on an ongoing basis to treat ED, depending on what is causing it. 9 Medications prescribed for ED include:
Counseling can help people address the social and psychological issues related to ED. This includes cognitive-behavioral therapy (CBT), mindfulness-based therapy (MBT), and sex therapy. Counseling may take place with couples or groups, or be conducted on a one-on-one basis.
A 2014 study in the Journal of Sexual Medicine concluded that counseling paired with a PDE5 inhibitor improved outcomes in men with ED better than either treatment on its own. 15
A vacuum pump, which can be purchased online or in sex shops, can be an option for people who have not seen benefits from using medication to treat ED.
The device consists of a cylinder that is placed over the penis and a hand pump that extracts air from the cylinder. The resulting vacuum draws blood into the penis, causing engorgement. 16
An elastic band can then be placed around the base of the penis behind the scrotum to maintain the erection.
If all other treatment options fail, surgery might be considered as a last resort. These procedures are especially beneficial for men with ED that's caused by diabetes, vascular disease, and spinal cord injury. 11
The two common surgical approaches used to treat ED are:
Many natural remedies found online or in supplement stores claim to improve erections. While few offer substantive proof of their effectiveness, a 2020 review of research from the University of the Western Cape in South Africa and the Cleveland Clinic concluded that five natural remedies showed promising results in treating ED. 17
Complementary and alternative ED therapies that might be beneficial include:
It is unclear how these remedies work to treat ED, but it is thought that they may stimulate nitrous oxide production, which the body uses to induce erections. 17
Erectile dysfunction (ED) often occurs in older people, but it can also occur in younger men—even in teens. However, the causes of ED in younger men may be different from the causes in older men.
In most cases, ED is treatable. There are a variety of conventional and alternative ways to address ED, and a combination of treatments that address the factors contributing to the condition can help people address their symptoms.
If you have ED at any age, talk to your doctor. You may then be referred to see a urologist for further evaluation and treatment.
It's also important to be open and honest about the condition when you are having sex with someone. When you are communicating with a partner, you can explore incorporating sexual activities that do not rely on penetration, such as vacuum pumps, sex toys, role play, mutual masturbation, and oral sex, into your experience.
Studies vary, but some suggest that as many 26% of men under the age of 40 have some degree of ED. 5 Other studies have reported around 8% in men ages 20–29 and 11% in men ages 30–39. 6
In the past, ED in younger men was primarily attributed to psychological causes such as depression and performance anxiety. Today, between 15% and 72% of cases of ED in younger men have a known organic cause, including: 10
If you have trouble getting or keeping an erection, ask your doctor if medications like Viagra (sildenafil) and Cialis (tadalafil) can help. Vacuum pumps can also help induce an erection.
As you and your doctor work on finding an effective ED treatment, communicate with your partner and explore incorporating toys, role play, mutual masturbation, and oral sex into your sex life.
Papagiannopoulos D, Khare N, Nehra A. Evaluation of young men with organic erectile dysfunction . Asian J Androl. 2015 Jan-Feb;17(1):11–16. doi:10.4103/1008-682X.139253
Ferrini MG, Gonzalez-Cadavid NF, Rajfer J. Aging related erectile dysfunction—potential mechanism to halt or delay its onset . Transl Androl Urol. 2017 Feb;6(1):20-7. doi:10.21037/tau.2016.11.18
Rastelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? . Transl Androl Urol. 2017 Feb:6(1):79-90. doi:10.21037/tau.2016.09.06
Shabsigh R, Perelman MA, Laumann EO, et al. Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries . BJU Int. 2004 Nov;94(7):1055-65. doi:10.1111/j.1464-410X.2004.05104.x
Centers for Disease Control and Prevention. Diabetes and men .
Muneer A, Kalsi J, Nazareth I, et al. Erectile dysfunction . BMJ . 2014;348:g129. doi:10.1136/bmj.g129
Ludwig W, Phillips M. Organic causes of erectile dysfunction in men under 40 . Urol Int . 2014;92:1-6. doi:10.1159/000354931
Yafi FA. Jenkins L, Albersen M. et al. Erectile dysfunction . Nat Rev Dis Primers. 2016;2:16003. doi:10.1038/nrdp.2016.3
Pastuszak AW. Current diagnosis and management of erectile dysfunction . Curr Sex Health Rep. 2014 Sep;6(3):164-76. doi:10.1007/s11930-014-0023-9
Hackney AC, Lane AR, Register-Mihalik J, O'Leary CB. Endurance exercise training and male sexual libido . Med Sci Sports Exerc . 2017 Jul;49(7):1383-8. doi:10.1249/MSS.0000000000001235
Montgomery Sklar E. Body image, weight, and self-concept in men . Am J Lifestyle Med. 2017 May-Jun;11(3):252-8. doi:10.1177/1559827615594351
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October 13, 2021, 2:49 PM · 4 min read
Santa Clara County District Attorney’s Office
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A 47-year-old California woman said to be married to a big-shot Silicon Valley executive is facing a slew of charges after prosecutors say she lured 14- and 15-year-old high school students to booze-fueled parties where she encouraged and watched “sometimes non-consensual” sex acts.
The allegations against Shannon O’Connor, also known as Shannon Bruga, run the gamut from plying minors with alcohol to enabling sexual assault. Prosecutors in Santa Clara County say she left a trail of victims over a period of several months.
At “drunken and destructive house parties” throughout 2020 and early 2021, O’Connor allegedly “bought vodka and Fireball whiskey, provided condoms, and discouraged the teens from telling their parents about the parties or calling for help when one of them passed out in their own vomit,” according to a press release from the Santa Clara County District Attorney’s Office.
In one instance outlined by prosecutors, O’Connor is said to have “watched and laughed as a drunk teen sexually battered a young girl in bed.” In another case, prosecutors say she “brought one drunk teen into a bedroom at her home where an intoxicated 14-year-old girl was lying in the bed,” leading to the girl being assaulted. The victim is said to have confronted her about the alleged setup, asking: “Why did you leave me in there with him? Like why did you like do that? Like you knew what he was going to do me.”
O’Connor is said to have gone to great lengths to keep the depraved scheme a secret, often allegedly using Snapchat or text messages to convince teenagers to sneak out of their homes in the middle of the night to attend one of her “parties.” She also kept the gatherings under wraps from her husband, Robert Amaral, the chief revenue officer of the cybersecurity firm SlashNext, according to The Mercury News .
The California-based parties are said to have gone on from June 2020 to May 2021. They were only stopped after parents learned of a December 2020 incident that left a boy with a concussion, The Mercury News reports. In that instance, which was also cited by prosecutors, O’Connor allegedly drove her son and his friends to the Los Gatos High School parking lot, where she let at least one of them drunkenly drive her SUV while her son and another friend hung on to the back. One of the teens fel
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