Erection Problems in Young Men

Erectile dysfunction is usually a consequence of complex interplay of nervous, hormonal and circulatory disturbances that can significantly affect the integrity of sexual and reproductive functions in males. Normal erection involves relaxation of cavernous tissue to accommodate increase flow of blood (brought by parasympathetic and sexual stimulation). Needless to say that any disconnect or disturbance in this circuitry can prevent males from achieving and maintaining optimal erection, needed to complete the act of intercourse.

The intensity and severity of erectile dysfunction depends on several factors; such as: age, comorbid medical health conditions, physical and psychological health and sexual preferences.

 

Are Erectile Problems Common in Young Males?

Research and clinical data indicates that ED is fairly common in elderly males. For example, according to a latest clinical survey, more than 86% males report erectile problems in males over the age of 80 years (1). However, unlike the common preposition, more than 25% males who seek medical help for the management of ED are under the age of 40 years (2). This corresponds to 1 in every 4 young males.

But what causes erectile problems in young males?

Clinical data indicates that 50% of all the cases of erectile dysfunction in young males are severe and require effective management besides behavioral therapy and lifestyle modification.  Most importantly, the severity of ED in these males increase with advancing age (making symptoms even worse). According to a research by the investigators from the University of Wisconsin, 40% of men have ED in their fourth decade of life while 50% in their fifth decade of life (3).

It is an awkward topic to discuss but an honest conversation with a physician can help in early diagnosis and prompt management. Certain statistically significant risk factors and causative agents include:

• History of Smoking or Alcohol Consumption: It has been observed that young males who consume excessive quantities of alcohol or engage in smoking/ drug related behavior are more likely to experience ED.
• History of Medical or Psychological Issues: Most frequently reported medical or psychological conditions that may lead to premature onset of ED are; diabetes, diseases of cardiovascular system, depression and stress.
• Hormonal Aberrations: Low levels of testosterone is the most frequently reported cause of ED in young males. Other hormones that are also associated with erectile issues are; prolactin (hyper-secretion) and thyroid disorders (hypo or hyper-secretion). Long term use of steroids can also cause ED (especially in athlete population).

 

How to Manage Erectile Problems in Young Males?

Experts believe that erectile issues can be adequately managed in young males with lifestyle changes, counselling and behavioral therapy and pharmacological agents. It is highly recommended to seek medical advice and treatment as sometimes, ED may be an early symptom of an underlying systemic issue.

Some helpful strategies to address erectile issues in young males are:

• PDE-5 Inhibitors: Phosphodiesterase-5 (PDE5) inhibitors are highly preferred and safe for the treatment of ED in young males. PDE5 enzyme influence the nitric oxide (NO) levels in the cavernous and vascular tissues and prolongs the duration of erection. Three most common prescription drugs for ED are sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).
• Vacuum Constriction Devices: If pharmacological options fail, other modalities can be tried like vacuum constriction devices which are considered safe and effective. A cylindrical device is placed over the shaft of penis to create vacuum inside the cylinder. When erection is achieved, a band is placed at the base of the penis to sustain the erection and cylinder is taken out. Band is to be removed half hour later (or after the completion of the act of intercourse.
• Surgical Intervention: Surgical implantation of penile prosthesis is the last resort. Non-complex models allow flexibility during micturition and intercourse. Complex models are designed to let the fluid fill in it and cause erection. There is a risk involved in the surgery like any other procedure. This shall be done in refractory to all other treatments case.

ED is an awkward condition to discuss but thought of not being alone is supporting. This can be treated and it can notify about other diseases as well. Direct and honest communication with physician can result in speedy and effective cure of the condition.

 

References:

1. Thorve, V. S., Kshirsagar, A. D., Vyawahare, N. S., Joshi, V. S., Ingale, K. G., & Mohite, R. J. (2011). Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management. Journal of diabetes and its complications, 25(2), 129-136.
2. Capogrosso, P., Colicchia, M., Ventimiglia, E., Castagna, G., Clementi, M. C., Suardi, N., … & Salonia, A. (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.
3. Egerdie, R. B., Auerbach, S., Roehrborn, C. G., Costa, P., Garza, M. S., Esler, A. L., … & Secrest, R. J. (2012). Tadalafil 2.5 or 5 mg administered once daily for 12 weeks in men with both erectile dysfunction and signs and symptoms of benign prostatic hyperplasia: results of a randomized, placebo‐controlled, double‐blind study. The journal of sexual medicine, 9(1), 271-281.

4. Wang, C., Jackson, G., Jones, T. H., Matsumoto, A. M., Nehra, A., Perelman, M. A., … & Cunningham, G. (2011). Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes care, 34(7), 1669-1675.