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Erectile Dysfunction in Your 20s: Causes and Treatment Options

Reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Published 11/04/2020

Updated 06/29/2023

Dealing with erectile dysfunction (ED) can be a stressful experience, especially if you’re a young, fit, healthy guy with no other obvious health problems. But when you start to understand how erections work, you’ll realize why ED can happen at any age. 

Getting hard is a complex, multi-step process that requires your brain, hormones, circulatory system and numerous other parts of your body to work in unison. And while you might assume older men are more likely to have health problems leading to erectile dysfunction , it can (and often does) affect younger men. 

If you’re in your 20s and sometimes find it difficult to get an erection, you’re not alone. According to the National Institutes of Health, about 30 million men in the United States are affected by erectile dysfunction — that’s roughly one in every five adult men.

The data doesn’t lie. Recent census data shows that more than a third of the population is over the age of 45, but in a small 2013 study , researchers noted that one out of every four men seeking treatment for erectile dysfunction is below the age of 40.

More concerning, about half of the men under the age of 40 in the study suffered from severe erectile dysfunction, meaning they were unable to attain or maintain an erection firm enough for penetrative sex.

If you’re in your 20s and find it hard to get an erection (or lose your erection easily), it’s best to talk to a healthcare provider to find out what’s causing it and what you can do to treat it. But there are a few more things you might want to know before starting the convo.

Below, we’ll explain how and why erectile dysfunction can occur in your 20s, as well as what you can do about it. We’ll also look at public statistics to see how prevalent ED is for men in their 20s, along with factors that may increase your risk of dealing with ED.

9 Causes of Erectile Dysfunction in Your 20s

There’s no singular cause of erectile dysfunction. Erection issues can be caused by a range of factors, from physical ones like cardiovascular health issues to psychological ones like performance anxiety, depression or potentially even overuse of pornography.

ED can signal that something else isn’t right in your body. As we’ll explain below, erectile dysfunction is often caused by issues like cardiovascular disease, high blood pressure, diabetes and other potentially serious health conditions and medical conditions.

Research also indicates that erectile dysfunction is a growing problem. A 1999 study published in BJU International concluded that ED would likely affect 322 million men worldwide by 2025 — an increase of about 170 million compared to the mid-90s.

By talking to a healthcare provider about your ED, you can identify what’s causing it and take action before the underlying issue becomes more serious — and some potential causes are already pretty serious.

High Blood Pressure (Hypertension)

Erections are all about healthy blood flow. If you have high blood pressure (aka hypertension ), you may have an elevated risk of developing erectile dysfunction due to the damage long-term high blood pressure can cause to your blood vessels.

This damage can affect blood flow throughout your body, making it difficult for blood to flow into the soft tissue of your penis when you’re aroused.

Some research also indicates that high blood pressure reduces your body’s production of sex hormones like testosterone — which plays a major role in regulating your sex drive. Studies have found that high levels of total and bioavailable testosterone may be associated with a stronger sex drive and better erectile function.

Being Overweight or Obese

As we learn more about what causes erectile dysfunction, science has observed a pretty clear link between obesity and ED.

ED is more common in people with cardiovascular disease or heart disease — a class of diseases that’s significantly more common in people who are overweight or obese. And yes, it can happen in your 20s.

There’s also evidence that losing weight can boost sexual performance and help get rid of erectile dysfunction. In an Italian study , overweight and obese men who lost an average of 33 pounds in two years reported improved erectile function.

Like high blood pressure, obesity is also associated with a lower level of testosterone — a key hormone for healthy erections and sexual performance. We explained the relationship between ED and low testosterone levels in more detail in our guide to weight and erection quality .

Diabetes is one of the main risk factors for ED early or late in life. It can damage blood vessels and affect your blood flow, making it more difficult for your body to supply blood to the soft tissue of your penis. It can also affect the nerves in and around your penis, potentially affecting sexual stimulation.

As we explained in our guide to diabetes and ED , these factors all contribute to an elevated risk of erectile dysfunction if you have diabetes. If you’re prediabetic or have other symptoms of diabetes, you may want to talk to a healthcare professional about whether it’s connected.

Your drinking habit might be one of the lifestyle changes you need to make as a college student or a recent grad. Not surprisingly, alcohol isn’t great for erectile health, and while a younger man’s hangover may not last as long, the effects of drinking on his erections can still add up.

While a drink or two is unlikely to hinder your sexual performance permanently, drinking alcohol excessively can affect your erections in both the short and long term.

In a 2007 study , researchers found that men with alcohol dependence syndrome had a high rate of sexual dysfunction. Of the 100 men who participated in the study, 72 percent had one or several forms of sexual dysfunction, with erectile dysfunction among the most common. 

A separate study from Hong Kong found that people who consumed more than three drinks per week were more likely to report erectile dysfunction than those who didn’t drink at all.

So if you’re a heavy or frequent drinker — or even just enjoy a drink socially — there’s a risk your drinking could be a contributing factor to erectile dysfunction. 

Young men are young enough to remember the anti-drug campaigns that bombarded them in school — but we’re pretty sure that if those campaigns included ED, they’d have more lasting effects on impressionable young minds. 

Using illicit drugs could increase your risk of developing erectile dysfunction and other sexual issues. Although in-depth research in this area is limited, there are clinical reports of erectile dysfunction in people who abuse drugs such as cocaine. Even recently legalized recreational drugs, such as cannabis, are closely linked to erectile dysfunction and other sexual dysfunctions in some research.

Smoking is closely linked to erectile dysfunction — and smokers are at an erectile disadvantage at any age. In a 2015 scientific review , researchers noted that cigarette smokers have an elevated risk of developing erectile dysfunction compared to people who don’t smoke.

Cigarettes and other tobacco products can damage your cardiovascular system. Specifically, the chemicals in cigarettes and other tobacco products can damage your heart and blood vessels, increasing your risk of developing high blood pressure and other cardiovascular conditions often linked to ED.

The nicotine in cigarettes can also cause your arteries to narrow, affecting the flow of blood throughout your body. Since erections are all about healthy blood flow, this isn’t a good thing for your sexual performance.

Our full guide to smoking and ED goes into more detail about the effects of cigarettes on erections and sexual health.

Sexual Performance Anxiety

Not every problem that affects young men is physical, however. In fact, sexual performance anxiety is a common problem affecting up to 25 percent of men.

With this condition, you might feel nervous or anxious about your appearance or sexual performance before and during sex. Performance anxiety can affect men and women of all ages. It can even hit young, otherwise healthy men who don’t see it coming.

As we explained in our guide to sexual performance anxiety and ED , feeling anxious or nervous before and during sex is closely associated with sexual dysfunction.

Difficulty Using a Condom

Call it a problem of inexperience, but if you use condoms incorrectly, struggle to put them on the right way or run into other problems while using this form of contraception, it’s far from uncommon for you to lose your erection. This is known as a condom-associated erection problem (CAEP).

CAEP can occur while you’re putting on a condom or just before, like if you feel anxious about making a mistake during condom application. It can also occur during sex if your condom isn’t put on properly, feels overly loose or tight or reduces sexual stimulation. 

Erectile dysfunction caused by condom issues is more common than you may think, especially for men in their 20s. In a 2015 study involving 479 men aged 18 to 24, almost 14 percent had CAEP while putting on a condom.

Another 16 percent had CAEP during penis-in-vagina sexual intercourse, while roughly 32 percent had CAEP while putting the condom on and while having sex.

One thing that might affect your ability to get an erection is porn. Though studies are limited, some research has found that watching porn can change the way your brain responds to sexual stimulation. This may result in a form of ED referred to as porn-induced erectile dysfunction .

Unlike some causes listed above, porn-induced ED isn’t caused by a disease or physical factor. Instead, it might be due to changes in the way you respond to sex that result from the limitless novelty, quantity and unique potential for escalation of internet-based porn.

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How to treat erectile dysfunction in your 20s.

As a younger guy, ED can feel like an embarrassing problem. After all, most guys who feel too young to struggle to get hard might deny there’s a problem until it’s too big to ignore.

We suspect one reason for this is fear of the unknown. So, how do you treat ED? It’s pretty simple — some of the most effective options are highlighted below.

Talk to a Healthcare Provider

Talking to a healthcare provider is essential to root out problems like diabetes, cardiovascular disease or high blood pressure. 

A healthcare provider might prescribe medication or recommend another type of treatment that may help to improve your health and sexual function. They can also help you identify medications that might have ED as a side effect.

If you’re not seeing the results you want, always talk with your healthcare provider about the ED medications you use and see if other options are available.

Consider ED Medications

Prescription medications for ED may sound scary to a 20-year-old, but as erectile dysfunction treatments go, they’re actually among the safest and most reliable options. 

Names like sildenafil (generic for Viagra ), tadalafil (generic for Cialis ), levitra (Vardenafil) and stendra (Avanafil) are FDA-approved medications available to treat erectile dysfunction.

These medications (called PDE5 inhibitors ) work by inhibiting certain enzymes that may prevent your erection from getting started — but they’ve come a long way since your dad’s little blue pill days. For instance, our chewable ED meds hard mints make taking ED medication easy and convenient.

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Strive for a Healthier Lifestyle

If you’re trying to fix ED or learn how to prevent ED , your lifestyle may have the biggest clues to offer about what needs attention.

Making changes to your habits and lifestyle to improve your health may help treat erectile dysfunction and boost your sexual performance. If you’re in your 20s and have symptoms of ED, try making the following changes:

If you’re obese or overweight, try to lose weight. 

Avoid consuming too much alcohol. 

If you smoke, quit.

Eliminate your drug use — for ED treatment and your general well-being.

One thing you may also want to consider is pelvic floor exercises. There’s some evidence that pelvic floor exercises may help improve erectile function.

We dug into the science behind these exercises and put together a list of basic movements you can do at home in our guide to ED exercises .

Put Your Mental Health First

You can put your mental health first in several ways, including:

Taking steps to manage stress and anxiety. Treatment options such as counseling, sex therapy and sexual performance anxiety therapy may help you get over performance anxiety and other psychological causes of ED .

Working on low self-esteem . Self-esteem issues may cause some penile problems in the form of performance anxiety for young people engaging in sexual activity.

Limiting your porn consumption. If you think porn might be affecting your erections and sexual performance, try watching it less than you normally do — or make an effort to avoid watching porn entirely. It may also help to talk to a therapist.

Talking to your partner. Sometimes, talking to your partner can help reduce anxiety and improve intimacy in the bedroom. Our guide to talking to your partner about ED explains how to make sexual performance-focused conversations easier.

And if you’re already dealing with mental health issues, remember that some antidepressants may cause ED — something you’ll want to discuss with a healthcare provider. But don’t discontinue using them without medical advice.

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Dealing with ed in your 20s.

Although erectile dysfunction is more prevalent in older men, it’s normal and far from uncommon to experience difficulty getting or maintaining an erection in your 20s. 

Dealing with ED can be stressful, especially when it affects budding relationships or a sex life that’s newer than your car. Here are some fast facts about the issue:

Yes, ED can affect men in their 20s.

One common problem for young men is psychological ED, which doesn’t have a physical component.

Luckily, almost all cases of ED are treatable with a combination of FDA-approved medications and lifestyle changes.

Solutions like online therapy and online psychiatry can help with the mental conflicts keeping you from getting hard.

If you’re in your 20s and have ED, don’t be afraid of talking to a healthcare provider. You’re not alone in your problem, and they can help you understand your options. We can help in the meantime.

Concerned about erectile dysfunction? Our guide to the most common treatments for erectile dysfunction goes into greater detail about the options available for treating ED and improving your sexual performance.

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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• Capogrosso P, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice. J Sex Med. (2013, Jul.). https://pubmed.ncbi.nlm.nih.gov/23651423/
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• Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current opinion in nephrology and hypertension, 21(2), 163–170. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004343/ .
• Ayta, I. A., McKinlay, J. B., & Krane, R. J. (1999). The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU international, 84(1), 50–56. https://pubmed.ncbi.nlm.nih.gov/10444124/ .
• Del Río, F. J., Cabello, F., & Fernández, I. (2015). Influence of substance use on the erectile response in a sample of drug users. International journal of clinical and health psychology : IJCHP, 15(1), 37–43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224805/ .
• Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479091/
• Dubey, R. K., Oparil, S., Imthurn, B., & Jackson, E. K. (2002). Sex hormones and hypertension. Cardiovascular Research, 53(3), 688-708. https://academic.oup.com/cardiovascres/article/53/3/688/328995 .
• Sanders, S. A., Hill, B. J., Janssen, E., Graham, C. A., Crosby, R. A., Milhausen, R. R., & Yarber, W. L. (2015). General Erectile Functioning among Young, Heterosexual Men Who Do and Do Not Report Condom-Associated Erection Problems (CAEP). The Journal of Sexual Medicine, 12(9), 1897-1904. https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.12964 .
• Betjes, E. (2014, January 7). What are condom-associated erection problems (CAEP)?. ISSM. https://www.issm.info/sexual-health-qa/what-are-condom-associated-erection-problems-caep/ .
• Lee, A. C., Ho, L. M., Yip, A. W., Fan, S., & Lam, T. H. (2010). The effect of alcohol drinking on erectile dysfunction in Chinese men. International Journal of Impotence Research, 22(4), 272-278. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/
• Pyke R. E. (2020). Sexual Performance Anxiety. Sexual medicine reviews, 8(2), 183–190. https://pubmed.ncbi.nlm.nih.gov/31447414/ .
• Kovac, J. R., Labbate, C., Ramasamy, R., Tang, D., & Lipshultz, L. I. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47(10), 1087–1092. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485976/ .
• Gades, N. M., Jacobson, D. J., McGree, M. E., St Sauver, J. L., Lieber, M. M., Nehra, A., Girman, C. J., Klee, G. G., & Jacobsen, S. J. (2008). The associations between serum sex hormones, erectile function, and sex drive: the Olmsted County Study of Urinary Symptoms and Health Status among Men. The journal of sexual medicine, 5(9), 2209–2220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586969/ .
• Akil, L., & Ahmad, H. A. (2011). Relationships between obesity and cardiovascular diseases in four southern states and Colorado. Journal of health care for the poor and underserved, 22(4 Suppl), 61–72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250069/ .
• Schwarcz, M., Swerdloff, R. S., & Wang, C. (2009). Obesity, low testosterone levels and erectile dysfunction. International Journal of Impotence Research, 21(2), 89-98. https://www.nature.com/articles/ijir200842 .
• U.S. Food and Drug Administration (FDA). How Smoking Affects Heart Health. (2021). https://www.fda.gov/tobacco-products/health-effects-tobacco-use/how-smoking-affects-heart-health
• American Heart Association. How Smoking and Nicotine Damage Your Body. (2023). https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-smoking-and-nicotine-damage-your-body

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here .

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Erectile Dysfunction In The 20s: What Men Need To Know

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Erectile dysfunction (ED) ¹ is the inability to produce or maintain an erection during sex. 

The cause of ED can be organic or non-organic. Physical issues cause organic ED, whereas psychological problems, such as stress and relationship concerns, cause non-organic ED.

The process of an erection starts with excitement and sexual arousal in the brain. This increases the blood flow to the penis while reducing the blood flow from the penis. 

The blood flow change creates a pressure buildup, leading to an erection. You may experience erectile dysfunction due to a disruption at any point in this process.

Yes. Although people may think ED happens with age and only older adults get ED, this is not true. You can get ED for many reasons, and it can occur as early as your 20s.

More older men develop ED than younger men, with over 70%² of men over 70 showing signs of ED. 

The risk factors for ED include lifestyle factors such as poor diet, excess consumption of alcohol, smoking, obesity, and low physical activity. 

These lifestyle factors are known for their contribution to chronic diseases such as heart disease, type 2 diabetes, and cancer. 

Like ED, these conditions are more common as people age because they have lived with these risk factors for longer. The cumulative effect of these lifestyle factors adds up over time, causing more issues to appear. 

Heart disease and diabetes are strongly linked¹ to ED. If you have either of these conditions, you have a high chance of having ED. 

It’s important to note that these factors lead to organic ED. Non-organic ED caused by psychosocial stress can affect men of all ages and doesn’t change with age. 

The age that men start presenting with ED is getting younger, which means more and more men in their 20s will be experiencing ED. 

One study³ estimated that the percentage of men with ED under 40 years old is 22%. 

Scientists have historically categorized younger men under 40 as one group, mainly psychogenic symptoms leading to their ED. However, a 2014 study⁴ found that 15–72% of men aged 18–39 have various organic reasons for their ED. 

This increase in men under 40 presenting with ED could be because of an increase in ED cases, or it could mean more men are reporting their ED symptoms to their doctors. If this increase is due to an uptick in reporting, it could indicate a greater trust of young men in their primary care physician. 

Most men in their 20s have a low risk of developing ED due to their young age. This results in younger men being overlooked and dismissed. 

It is much more common for young men to be experiencing ED as a result of non-organic psychological stress or as a side effect of a medication they are on. 

Hypertension

Hypertension⁵ (high blood pressure) can cause organic ED, just as ED can lead to hypertension. This process is caused by underlying damage to your blood vessels, often due to lifestyle factors. It’s not normally a condition you would see in someone in their 20s, but some young people may develop hypertension due to genetic factors. 

In young, non-diabetic, obese men, the risk of ED increases as body mass index (BMI) increases. Of these men, those with more fat distributed around their abdomen are at a greater risk. This means that if you have a high BMI and a “beer belly,” you have a higher chance of developing ED. 

Type 2 diabetes is most commonly related to ED. Having either of these conditions is a risk factor for developing the other.

However, as type 2 diabetes is a condition mainly caused by long-term exposure to lifestyle factors, it affects less than 5% of Americans⁶ aged 18–44. Due to this, it is less likely the cause of ED is in your 20s.

Type 1 diabetes is a condition where the disease onset is much younger, including in children and young adults. Both type 1 and type 2 diabetes can damage your blood vessels if they are not well-controlled. Because of this, if you have type 1 diabetes, it may be contributing to your ED. 

Excessive alcohol intake may be a risk factor for ED. In low amounts, alcohol appears to reduce the risk of developing ED. Moderate consumption can have protective benefits on the cholesterol composition of the body and help with blood flow and other variables associated with ED. 

In terms of recreational drug use, there is strong evidence that suggests that smoking is a risk factor for ED. Tobacco smoking can damage your blood vessels and cause ED. It is a dose-dependent relationship, meaning the more cigarettes you smoke, the higher your risk of developing ED. 

For this reason, you may think that men in their 20s haven’t been smoking for long enough. Younger, heavy smokers, who smoke 20 or more cigarettes daily, still face significant risk. They are more likely to develop severe ED than those who smoke less. 

Using other recreational drugs such as cannabis is a risk factor for blood vessel damage and the development of ED.

Many people are unaware that many medications have side effects that can affect your sexual function. This is called treatment-emergent sexual dysfunction⁷ (TESD) and can cause ED. 

Common medications that cause ED include antidepressants. Because it can be an uncomfortable topic, some doctors won’t explain these potential side effects when prescribing these drugs, and people often don’t want to talk to their doctors about their ED symptoms. The TESD is likely to stop when you stop taking the medications. 

However, this is not always easy to fix, as antidepressants and antipsychotics are often long-term treatments. Some management strategies are available, so if this issue seems familiar to you, please talk to your doctor about your symptoms. 

Mental health

Psychogenic factors, or non-organic causes of ED, contribute to many ED cases, especially in younger men. In many cases, you can improve these factors through things like therapy and couples counseling. 

Psychogenic factors that could be causing your ED include:

Clinical depression

Clinical anxiety disorder

Performance anxiety or “stage fright”

Lack of stimulation

Relationship conflicts

High psychological stress

Sexual trauma

Sexual identity or sexual orientation issues 

Medical disorders  

Men who have multiple sclerosis or epilepsy have an increased risk of developing ED. Trauma in and around the groin can also potentially cause ED. These disorders aren’t related to age, which can affect men in their 20s. 

Lastly, Peyronie’s disease, caused by an injury to the penis, can lead to ED. This disease takes time to develop, but up to 8% of men with Peyronie’s disease are under 40. Of those, 21% have ED. 

Some men experience condom-associated erection problems (CAEP)⁸ due to ill-fitting condoms or how they affect the sensation in the penis. As you need to use condoms for safe sex, ensure you know how to use condoms correctly. Buying the right size can avoid CAEP.

The main symptoms of ED are the inability to produce or maintain an erection. ED symptoms can range from mild to severe. Mild would almost always be able to get and maintain an erection for sex, while severe would never be able to produce or maintain one. More severe ED symptoms are often apparent in older men. 

Not being able to properly sexually function can seriously impact your sex life and sexual satisfaction. Men experience a lot of stress and shame due to being unable to “get it up” or losing an erection during sex. This can negatively impact your mental and social well-being. 

If you have ED at a young age, even without the related conditions, you might be at an increased risk of developing them. 

As ED and these chronic diseases have risk factors in common, such as obesity, diet, alcohol, and smoking, ED may be an initial indicator that your current lifestyle may need improvement. 

Lifestyle modifications 

The first port of call for treating ED in young men is trying lifestyle modifications. These include: 

Weight loss which positively benefits ED

The Mediterranean diet is a diet high in anti-inflammatories and antioxidants. It focuses on nuts, seeds, olive oil, whole grains, fruits, and vegetables. A study found that higher intakes of fruits and vegetables decreased the risk of ED in young men.

Stop smoking , as smoking increases your risk of ED. If you stop smoking, you will decrease your risk.

Reduce alcohol intake , especially if your alcohol intake is high. Reducing it to lower levels will help improve your ED.

More physical activity improves erectile function. 

Psychological support

Especially in cases of non-organic ED, some mental health support can improve your symptoms. Because many different psychological factors can cause non-organic ED, many treatments exist. These include: 

Therapy or medication to reduce anxiety or depression symptoms

Therapy for general stress relief

Support for past traumas

Increased sexual stimulation

Couples communication training 

Medications 

PDE-5 inhibitors⁹ are the most common medical treatment for men with ED. These drugs increase blood flow to your penis, giving you an erection. They require stimulation or sexual arousal to work. They include:

If you’re experiencing ED as a side effect of a medication you are taking, some options may help. If you stop taking the drug, your ED symptoms will also stop. 

Sometimes this is not recommended, as some medications that cause ED are essential for the long-term management of disorders such as depression or schizophrenia. These medications include antidepressants and antipsychotics. 

Please consult your doctor if you wish to stop taking medication because your ED is a problem. They may be able to help by prescribing a different medication that won’t give you ED, or they might try to improve your tolerance for the drug.

Testosterone therapy 

In cases where low testosterone levels may cause your ED, testosterone therapy¹⁰ may restore your sexual function. You can administer this therapy as an injection, skin patch, tablet, or topical gel. 

Vacuum erection devices

A vacuum device (a pump) is a non-invasive method to produce an erection. Placing this device over the penis creates a vacuum, increasing blood flow to the area and producing an erection. 

Penis implants

For men with severe ED, for which other treatments such as lifestyle changes and medications have not worked, a penis implant may be a good option to restore sexual function. 

How you manage ED in your 20s won’t look that different from how you would handle it later in life. Implement the lifestyle modifications that are relevant to you, use the medicine that works best for you, and live a normal life. 

You should visit your doctor at any point where you suspect you might have ED, or you know you have ED and feel like it negatively impacts your mental, social, or sexual health. 

You should also consult your doctor before stopping any medications if you are experiencing any side effects from the medications you are on. 

You can experience erectile dysfunction in your 20s; it is normal and common. Many things could be causing your ED, including lifestyle factors, medications, or psychological stress. 

Overall, there is no need to worry, as there are many changes you can make and medications you can take to help manage your ED. Speak to your doctor to get the ball rolling on your treatment plan. 

Erectile dysfunction (2020)

Prevalence and risk factors for erectile dysfunction in the US (2007)

Erectile dysfunction (2016)

Organic causes of erectile dysfunction in men under 40 (2014)

Hypertension and erectile dysfunction: Breaking down the challenges (2020)

National diabetes statistics report 2020 | Centers for Disease Control and Prevention

Management strategies for antidepressant-related sexual dysfunction: A clinical approach (2019)

Condom use errors and problems: A global view (2012)

PDE5 inhibitors | NIH: National Library of Medicine

Testosterone therapy in erectile dysfunction (2009)

Other sources:

Erectile dysfunction | NIH: National Library of Medicine

Erectile dysfunction in fit and healthy young men: Psychological or pathological? (2017)

Effect of prescription medications on erectile dysfunction (2017)

Investigation and treatment of high blood pressure in young people (2019)

Genetics of human primary hypertension: Focus on hormonal mechanisms (2019)

Prevalence of and risk factors for erectile dysfunction in young nondiabetic obese men: Results from a regional study (2020)

Impotence and its medical and psychosocial correlates: Results of the Massachusetts male aging study (1994)

Diabetes and sexual dysfunction: Current perspectives (2014)

Prevalence of sexual dysfunction in male subjects with alcohol dependence (2007)

Effects of cigarette smoking on erectile dysfunction (2015)

Psychogenic erectile dysfunction: Classification and management (2021)

Age at first presentation for erectile dysfunction: Analysis of changes over a 12-yr period (2019)

Male (External) condom use | Centers for Disease Control and Prevention

Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial (2004)

Sexual dysfunction among young men: Overview of dietary components associated with erectile dysfunction (2018)

IPASS: A study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men (2013)

Comparison of testosterone replacement therapy medications in the treatment of hypogonadism (2016)

External penile rigidity devices - Class II special controls guidance document for industry and FDA staff | U.S. Food and Drug Administration

The use of vacuum erection devices in erectile dysfunction after radical prostatectomy (2013)

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Weight loss, daily health, top products, what we treat, erectile dysfunction (ed) in young men: is ed in your 20s normal.

Reviewed by Chimene Richa, MD , written by Michael Martin

table of contents

What is erectile dysfunction (ed), how many men in their 20s have ed, causes of erectile dysfunction in your 20s, treatments for young men with ed , working with a healthcare provider.

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

No matter your age, not being able to get an erection when you want one is frustrating. But, if you’re in your 20s or 30s and find that you’re unable to get or maintain an erection, you may be wondering if what’s going on down there is normal. 

Erectile dysfunction (ED) in younger men is much more typical than previously thought. In fact, some estimates show that up to 30% of men under 40 experience erectile dysfunction ( Nguyen, 2017 ). That said, if you’re a previously healthy guy, erectile dysfunction in younger men could be a sign of a more serious health condition. Let’s dive a bit more into some stats surrounding ED in young men and some of the causes of erectile dysfunction in your 20s.

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ED occurs when you can’t get or maintain an erection sufficient for satisfying sex. That might include erections that don’t last as long as you want or aren’t as firm as you’d like. It’s the most common sexual dysfunction . In fact, it’s estimated that 30–50 million American men have experienced it ( Sooriyamoorthy, 2020 ). But, how common is erectile dysfunction for men in their 20s?

Several studies conducted in the past decade have found a sharp increase in the number of men under 40 reporting ED—a condition once considered exclusive to older men . 

For example, an Italian study published in 2013 noted that, out of 439 men who had erectile dysfunction, 114 (26%) were younger than 40 ( Capogrosso, 2013 ). And nearly half of those young men had “severe” ED, according to the International Index of Erectile Function (IIEF), a 15-item questionnaire that assesses erection frequency and quality.

So, is something causing ED to skyrocket among young guys in their 20s? The answers are complicated. 

Researchers haven’t definitively determined that the rising numbers of young men reporting ED are caused by something specific that’s going on in that age group, but there are several theories. 

A possible cause is that the increase in ED among younger men is due to the development of effective treatments for the condition. After all, Viagra was only introduced in the mid-’90s. That has led to greater awareness of ED, enabling young men to reach out to their healthcare providers, whereas in previous generations, they might have suffered in silence.

Awareness aside, some psychological and physical causes of ED may also be to blame.

Psychological causes of ED in younger men

Some scientists think the rise of internet porn might be affecting young men’s psychological approach to sex and dampening their sex lives. However, a 2019 review of studies found insufficient evidence to support that hypothesis ( Dwulit, 2019 ). 

Other potential psychological causes that do have science to back them up include self-esteem issues, performance anxiety , general anxiety , or depression ( Rew, 2016 ).

Physical causes of ED in younger men

If you’re pretty sure your mental health isn’t causing your ED, there are certain physical causes of erectile dysfunction in younger men. Obesity, alcohol or tobacco use, and drug abuse may play a role. Additionally, ED can occur as a side effect of certain medications, including antidepressants (Rew, 2016). 

Aside from these lifestyle factors, some medical conditions can also cause ED. 

ED can be an early sign of a more significant health condition such as heart disease, low testosterone , high blood pressure, high cholesterol, or diabetes (Sooriyamoorthy, 2021). 

Because the blood vessels in the penis are smaller than in other parts of the body, ED symptoms sometimes occur before more serious problems strike, such as a heart attack or stroke (Sooriyamoorthy, 2021). So, when an otherwise healthy man in his 20s experiences ED, it could be cause for concern. This is why it’s essential to talk with a healthcare provider as soon as possible if you’re a younger man with erectile dysfunction.

Treating your ED will ultimately depend on its cause. Medications, natural remedies, and lifestyle changes may all be helpful. Let’s dive into each of them now (Sooriyamoorthy, 2021): 

Oral medications

Prescription medications for ED are highly effective. Several are available, including sildenafil (brand name Viagra; see Important Safety Information ), tadalafil (brand name Cialis ; see Important Safety Information ), and vardenafil (brand name Levitra). 

Testosterone therapy

If low testosterone is responsible for your erectile dysfunction, testosterone replacement therapy (TRT) can boost your testosterone levels via injection , a wearable patch , or gel applied to the skin. 

External vacuum devices

For some young men with ED, this non-surgical option—more commonly known as a “ penis pump ”—may prove to be helpful. Essentially, you place a cylinder over your penis and make sure it’s sealed tightly. Then, you use a vacuum pump that causes an “artificial” erection that can last for up to 30 minutes. 

Natural remedies and lifestyle changes

Some men have found natural remedies for ED to be effective. Some studies have shown that certain supplements (such as DHEA , ginseng , L-arginine , L-carnitine, and Yohimbe) may be helpful. 

Aside from supplements, your erections will be best when you’re healthy. Making simple lifestyle changes, such as getting regular exercise, eating a healthy diet, quitting smoking, and limiting your alcohol consumption, might be enough to improve your ED.

Penis implant surgery

For severe ED, when all other treatment options have failed, a surgically placed penis implant has been effective in restoring sexual function.

For many younger men, talking about erectile dysfunction can be difficult. But rest assured that you are far from alone, and your healthcare provider can help you find a solution that’s right for you—and can potentially catch other health problems that may be causing your ED.

• Capogrosso, P., Colicchia, M., Ventimiglia, E., Castagna, G., Clementi, M. C., Suardi, N., et al. (2013). One patient out of four with newly diagnosed erectile dysfunction is a young man—worrisome picture from the everyday clinical practice. The Journal of Sexual Medicine, 10 (7), 1833–1841. doi: 10.1111/jsm.12179. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23651423/  
• Dwulit, A. D., & Rzymski, P. (2019). The potential associations of pornography use with sexual dysfunctions: an integrative literature review of observational studies. Journal of Clinical Medicine, 8 (7), 914. doi: 10.3390/jcm8070914. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31247949/  
• Janjgava, Sh., & Doliashvili, T. (2016). Erectile dysfunction as a predictor of cardiovascular disease. Georgian Medical News, (261) , 36–41. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28132040/  
• Nguyen, H., Gabrielson, A., & Hellstrom, W. (2017). Erectile dysfunction in young men – a review of the prevalence and risk factors. Sexual Medicine Reviews, 5 (4), 508–520. doi: 10.1016/j.sxmr.2017.05.004. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28642047/  
• Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current Opinion in Nephrology and Hypertension, 21 (2), 163–170. doi: 10.1097/mnh.0b013e32835021bd. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22240443
• Rew, K. T., & Heidelbaugh, J. J. (2016). Erectile dysfunction. American Family Physician , 94(10), 820–827. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27929275/ .
• Sooriyamoorthy, T., & Leslie, S. (2021). Erectile Dysfunction. [Updated Aug 12, 2021]. In: StatPearls [Internet]. Retrieved Dec. 8, 2021 from https://pubmed.ncbi.nlm.nih.gov/32965924/

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Erectile dysfunction pills and medications: viagra, cialis, and more, 8 natural remedies and treatments for erectile dysfunction, sex therapy: a method to rejuvenate your sex life, important safety information for sildenafil (viagra), what are the most important things i need to know about viagra® (sildenafil citrate) 25 mg, 50 mg, and 100 mg tablets and generic viagra®.

Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.

• an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis.
• sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
• sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away
• VIAGRA ® does not protect against sexually transmitted diseases, including HIV.

Who should not take VIAGRA® or generic VIAGRA®? 

Do not take VIAGRA® or generic VIAGRA® if you:

• Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
• Are allergic to sildenafil, as contained in VIAGRA ® and REVATIO ® , or any of the ingredients in VIAGRA® or generic VIAGRA® tablets.
• Are a women or a child

When should I call my primary provider? 

Call your primary provider right away if you:

• Have an erection that lasts longer than 4 hours
• Experience a sudden loss of vision in one or both eyes
• Experience a sudden decrease in or loss of hearing
• Experience chest pain, dizziness, or nausea during sex
• Take too much Viagra or sildenafil citrate 

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

What are the most common side effects of VIAGRA® and generic VIAGRA®?

The most common side effects are:

• upset stomach
• abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
• stuffy or runny nose
• muscle pain

What should I tell my Roman-affiliated provider before taking VIAGRA® and generic VIAGRA®?

Before you take VIAGRA ® or generic VIAGRA ® , tell your healthcare provider if you:

• Have or have had heart problems such as a heart attack,irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
• Have had heart surgery within the last 6 months
• Have pulmonary hypertension
• Have had a stroke
• Have low blood pressure, or high blood pressure that is not controlled
• Have a deformed penis shape
• Have had an erection that lasted for more than 4 hours
• Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
• Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
• Have ever had severe vision loss, including an eye problem called NAION
• Have bleeding problems
• Have or have had stomach or intestinal ulcers
• Have liver problems
• Have kidney problems or are having kidney dialysis
• Have any other medical conditions 

Tell your healthcare provider about all the medicines you take , including prescription and over-the-counter medicines, vitamins, and herbal supplements.

VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects.

Especially tell your healthcare provider if you take any of the following:

• Medicines called nitrates
• Medicines called guanylate cyclase stimulators such as Adempas ® (riociguat)
• Medicines called alpha-blockers such as Hytrin ® (terazosin HCl), Flomax ® (tamsulosin HCl), Cardura ® (doxazosin mesylate), Minipress ® (prazosin HCl), Uroxatral ® (alfuzosin HCl), Jalyn ® (dutasteride and tamsulosin HCl), or Rapaflo ® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA ® with alpha-blockers can lead to a drop in blood pressure or to fainting
• Medicines called HIV protease inhibitors, such as ritonavir (Norvir ® ), indinavir sulfate (Crixivan ® ), saquinavir (Fortovase ® or Invirase ® ), or atazanavir sulfate (Reyataz ® )
• Oral antifungal medicines, such as ketoconazole (Nizoral ® ) and itraconazole (Sporanox ® )
• Antibiotics, such as clarithromycin (Biaxin ® ), telithromycin (Ketek ® ), or erythromycin
• Other medicines that treat high blood pressure
• Other medicines or treatments for ED
• VIAGRA ® contains sildenafil, which is the same medicine found in another drug called REVATIO ® . REVATIO ® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA ® should not be used with REVATIO ® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What is the FDA-approved use of VIAGRA® and generic VIAGRA®?

VIAGRA ® (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED). 

Roman-affiliated doctors may prescribe VIAGRA® or generic VIAGRA® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment. While this is not an FDA-approved use of the drug, the American Urological Association has included the use of sildenafil citrate in the treatment of PE in its Guideline on the Pharmacologic Management of Premature Ejaculation .  

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see the full Prescribing Information for complete safety information. 

Product names referenced herein are trademarks of their respective owners.

Important Safety Information for Tadalafil (Cialis)

What is the most important information i should know about cialis® (tadalafil) and generic cialis® .

• An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections. 
• Changes in vision. Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green. 
• Sudden decrease or loss of vision. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS® and generic CIALIS®) reported a sudden decrease or loss of vision in one or both eyes. It is uncertain whether PDE5 inhibitors directly cause the vision loss. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS® and generic CIALIS®, and call a healthcare provider right away. 
• Sudden loss or decrease in hearing. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS® and generic CIALIS®. It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors. If you experience these symptoms, stop taking CIALIS® and generic CIALIS® and contact a healthcare provider right away. 
• CIALIS® and generic CIALIS® can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke. 
• Never take CIALIS® or generic CIALIS® with any nitrate or guanylate cyclase stimulator medicines. Do not take CIALIS® or generic CIALIS® if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm. Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. 
• Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite. 
• Do not take CIALIS® or generic CIALIS® if you take medicines called guanylate cyclase stimulators which include: Riociguat (Adempas®) a medicine that treats pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (pulmonary hypertension due to chronic blood clots in the lungs). Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates or guanylate cyclase stimulators, such as riociguat. 
• Tell all of your healthcare providers that you take CIALIS® or generic CIALIS®. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took CIALIS® or generic CIALIS®. After taking a single tablet, some of the active ingredient of CIALIS® or generic CIALIS® remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications. 
• Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease. 
• ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.
• CIALIS® and generic CIALIS® help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Some form of sexual stimulation is needed for an erection to happen with CIALIS® or generic CIALIS®. 
• Cure ED 
• Increase a man’s sexual desire 
• Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases. 
• Serve as a male form of birth control 
• Do not use CIALIS® or generic CIALIS® with other ED medications.
• CIALIS® and generic CIALIS® are only for men over the age of 18, including men with diabetes or who have undergone prostatectomy. 
• CIALIS® and generic CIALIS® are not for women or children. 
• Take CIALIS® or generic CIALIS® exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Do not change your dose or the way you take CIALIS® or generic CIALIS® without talking to your healthcare provider.

Who Should Not Take CIALIS® or generic CIALIS®? 

Do not take CIALIS® or generic CIALIS® if you:

• Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
• Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
• Take any medicines called “nitrates” 
• Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite 
• Take any medicines called guanylate cyclase stimulators, such as riociguat 
• Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients

When should I call my primary provider?

Call your primary provider right away if you: 

• Experience a sudden loss of vision in one or both of your eyes
• Experience a sudden decrease or loss hearing
• Take too much CIALIS® or generic CIALIS® 
• Have an allergic reaction to CIALIS® or generic CIALIS®
• Symptoms of an allergic reaction may include: 
• Hives 
• Swelling of the lips, tongue, or throat 
• Difficulty breathing or swallowing 

Call your healthcare provider or get help right away if you have any of the symptoms of an allergic reaction listed above.  

What Should I Tell My Roman-affiliated Provider Before Taking CIALIS® and generic CIALIS®? 

Tell your Roman-affiliated provider about all your medical problems, including if you:

• Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. You should not take CIALIS® and generic CIALIS® if your healthcare provider has told you not to have sexual activity because of your health problems. 
• Have low blood pressure or have high blood pressure that is not controlled 
• Have had a stroke 
• Have liver problems 
• Have kidney problems or require dialysis 
• Have retinitis pigmentosa, a rare genetic (runs in families) eye disease 
• Have ever had severe vision loss, including a condition called NAION 
• Have stomach or intestinal ulcers 
• Have a bleeding problem 
• Have a deformed penis shape or Peyronie’s disease 
• Have had an erection that lasted more than 4 hours 
• Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia 

Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. 

Especially tell your healthcare provider if you take any of the following: 

• Medicines called nitrates 
• Medicines called guanylate cyclase stimulators, such as riociguat (Adempas®), used to treat pulmonary hypertension 
• Medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), 4 Jalyn® (dutasteride and tamsulosin HCl) or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS® or generic CIALIS® is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
• Other medicines to treat high blood pressure (hypertension) 
• Medicines called HIV protease inhibitors, such as ritonavir (Norvir® , Kaletra® )
• Oral antifungals such as ketoconazole (Nizoral® ), itraconazole (Sporanox® ) 
• Antibiotics such as clarithromycin (Biaxin® ), telithromycin (Ketek® ), erythromycin (several brand names exist. Please consult your healthcare provider to determine if you are taking this medicine). 
• Other medicines or treatments for ED. 
• Tadalafil is also marketed as ADCIRCA® for the treatment of pulmonary arterial hypertension. Do not take both CIALIS® or generic CIALIS® and ADCIRCA®. Do not take sildenafil citrate (Revatio®, Viagra®) with CIALIS® or generic CIALIS®. 

What are the most common side effects of CIALIS® or generic CIALIS®?

The most common side effects with CIALIS® and generic CIALIS® are:

• Indigestion
• Muscle aches
• Stuffy or runny nose

What is the FDA-approved Use of CIALIS® and generic CIALIS®? 

CIALIS® and generic CIALIS® are prescription medicines used to treat erectile dysfunction (ED), symptoms of benign  prostatic hyperplasia (BPH), or both.

Roman-affiliated doctors may prescribe CIALIS ® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.  

Dealing with ED in your 20s and 30s

If you’re having erectile problems, don’t ignore them. Learn what can cause erectile dysfunction in younger guys — and when you should see a doctor to get help. 

Jennifer Howze

You probably think of erectile dysfunction (ED) as a condition that mainly affects older men. But it can happen to men in their 20s and 30s, too. Some studies suggest that up to 30% of younger men deal with ED.

You might assume that ED issues in younger men are just one-off events and that the problem will go away on its own. It’s true that having erection trouble every once in a while isn’t necessarily cause for concern, according to the Mayo Clinic. But that doesn’t mean guys under 40 should just accept erectile problems. Understanding why ED happens when you’re young can get you back on track in the bedroom.

Psychological causes of ED in young men

ED in younger men often has a psychological cause, says Tracy Gapin, MD. He’s a board-certified urologist and founder of the Gapin Institute in Sarasota, Florida. Some of the ways that your brain can get in the way of your erection include:

Performance anxiety. This happens when you worry so much about having an erection that you can’t get one. “It’s actually mental. Guys will have this vicious cycle where they occasionally can’t perform for whatever reason, and it gets in their head that they can’t perform,” Dr. Gapin says.

Being embarrassed about the problem just makes it worse. Younger men can have “a feeling that it’s not normal, that I’m too young to have this,” says Dr. Gapin. This can lead to insecurity and depression.

Using pornography. Frequent use of pornography might contribute to ED in younger men. “They especially use porn with masturbation,” says Dr. Gapin. “It causes the brain to require more and more dopamine stimulation to cause pleasure.” (Dopamine is a brain chemical that’s connected to sexual arousal.)

When you have intercourse with a partner in a real-world situation, it doesn’t quite live up to the fantasies. And that means the dopamine stimulation isn’t as high. This can lead to problems getting and maintaining an erection. The result: You don’t want to initiate sex because you’re afraid you won’t be able to perform. It’s that vicious cycle again. In these instances, Dr. Gapin often recommends counseling or coaching to help resolve the issues.

How medication can help. A prescription for a medication such as sildenafil (Viagra ® ), vardenafil (Levitra ® ) or tadalafil (Cialis ® ) could also be a solution if you’re experiencing psychological ED issues.

In some cases, the medication helps guys gain confidence as well as improve erections, says Marc Cohen, MD. He’s a urologist in Sarasota, Florida, and a medical adviser at Bastion Health, which specializes in male fertility and prostate health. “The patient sees a response and gets encouraged,” which in turn boosts confidence and reduces performance anxiety, he says.

It’s important to get your own prescription and not borrow a friend’s medication, cautions Dr. Cohen. That’s because the individual response to dosage can vary, and the medication can interact with other medications you take. (Find out which ED medication is best for you.)

Treat ED on your terms. Get discreet care from the comfort of home and medication delivered to your door. Learn more .

Lifestyle factors that can cause ED

Party people, beware. Smoking, drinking and using recreational drugs can definitely affect your erections. Consider:

• Alcohol. It depresses your central nervous system, interfering with the brain and hijacking the signals that help lead to an erection.  
• Heavy cigarette smoking. This is a risk factor for ED in younger men, and it’s harmful for your health overall. Smoking increases your risk of vascular disease, hardening of arteries and narrowing of blood vessels (all issues related to blood flow). And all of these conditions increase the risk of erectile problems.  
• Marijuana. ED is twice as high in guys who smoke marijuana than in those who don’t, according to a 2019 review study in American Journal of Men’s Health .  
• Illicit drugs. Cocaine, opiates, amphetamines and other illicit drugs can also cause ED, according to the Cleveland Clinic.

Be honest with your doctor if you use of any of these substances. Your doctor needs to have this information before prescribing any medication. He or she can also suggest lifestyle changes that may help improve your ED.

Potential physical causes for ED in younger men

There are some underlying health conditions in younger men that can contribute to ED. These include:

• Cardiovascular problems
• High blood pressure
• High cholesterol
• Congenital heart defects

One of the most serious underlying causes is heart disease. The ED itself can be a warning sign that you’re at risk for a heart attack. It’s true that younger men have an overall lower risk of cardiovascular events. But this could be an early opportunity to discuss erectile problems, as well as any cardiovascular issues before they become more damaging.

Physical factors can be overlooked in younger men, so a face-to-face doctor’s appointment is valuable, says Dr. Cohen. Your doctor can do a general exam and health check to identify problems or rule them out. (Read more about the physical causes of ED.)

Sometimes treating the underlying health problem can improve ED issues. Your doctor will also consider other medications you take. For example, antidepressants can dampen your interest in sex.

The bottom line: You don’t have to suffer with ED problems. Whether the cause is related to physical, lifestyle or psychological issues, you have a wide range of treatments and tools to improve your sex life. Addressing the problem now can even benefit your health later in life.

Even occasional ED can be treated. Get personalized, discreet care and low-cost medication delivered to your door. Your first consult is free.  

Additional sources Prevalence: Sexual Medicine Reviews (2017). “Erectile Dysfunction in Young Men — A Review of the Prevalence and Risk Factors” ED basics: Mayo Clinic (n.d.). “Erectile Dysfunction” Illicit drug use: Cleveland Clinic (2019). “Erectile Dysfunction”

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“Help!!!  I have erectile dysfunction and I’m only 30!”

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.

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