Younger Men and Erectile Dysfunction

By Deborah Jeanne Sergeant

J. C. Trussell, urologist with Upstate Medical University: “We can treat ED. Most guys do not need surgery and have a good response with oral medication.”

Historically, erectile dysfunction represents a health issue that most men older than 45 face to an extent.

But in recent years, the number of cases of ED in younger men has increased.

According to the multinational Men’s Attitudes to Life Events and Sexuality (MALES) study published by the National Institutes of Health, about 8% of men aged 20-29 and 11% of men 30-39 have ED.

“The Massachusetts Male Ageing Study determined that at approximately 20 years of age, 20% of men will complain of some form of ED — but this covers mild, moderate and severe [cases]. At 30 years of age, it is 30%, and so on.”

Compared with previous cohorts, more young men are contacting a healthcare provider to treat their ED, according to several studies. But does this mean that more have ED or that they feel more comfortable presenting with ED at their doctor’s office than the previous generation?

“We can treat ED. Most guys do not need surgery and have a good response with oral medication,” said physician J. C. Trussell, urologist with Upstate Medical University. “If the patient is young, they won’t need it forever once they get out of the situation causing stress.”

He explained that because stress slows down the reproductive path, men have trouble getting and maintaining erections. Trussell has observed couples who want to have a baby typically succeed despite ED once they manage their stress. Cruelly, stress can cause ED and ED can fuel stress — a vicious cycle.

ED at young age can indicate heart problems. Blood vessels in the penis are 1 to 2 milimeters in diameter, compared with coronary arteries, which are 3 to 4 milimeters and carotid arteries, which are 5 to 7 milimeters. This means that ED in young men can indicate heart disease is present also. Numerous studies report that cardiovascular disease is increasing among young adults because of poor diet, unmanaged stress and lack of exercise.

Trussell also said that injuries to blood vessels supplying the penis can lessen blood flow to it and thereby hamper erections.

Physician Ryan Sidebottom, urologist with Auburn Community Hospital, also views ED as a multifaceted issue. In addition to greater reporting and the psychological components affecting young men, Sidebottom noted that “we’re seeing more early onset diabetes, metabolic syndrome and obesity. It can affect vascular health and hormonal health and that can affect erections.” For more information on vascular health, you may visit https://foxvalleysurgical.com/surgical-specialties/vascular-endovascular-surgery/.

He said that essential to any exam involved ED is a general medical history, medication review, lab work and addressing any metabolic issues. For example, men who are diabetic need to address weight and control their blood sugar levels. Those with low testosterone may seek replacement therapy. Smoking cessation can help increase blood flow throughout the body.

For many men, using medication can help achieve better erections. Sidebottom noted that phosphodiesterase inhibitors (PDE 5) help by stimulating the nerve going to the penis to increase blood flow and with dilation of the penis.

“If this fails, there are further options for ED,” Sidebottom said. “There are injections that can go into the blood vessels to the penis. There are tablets that can be placed in the urethra that can cause dilation into the penis.  And vacuum pumps. They can help draw venous blood into the penis. And surgical interventions with penile prostheses. It replaces the chambers that fill with blood with chambers attached to a pump to fill the balloons to fill with water as desired. There is a very high satisfaction rates. It’s a big step and a last step in the process. But it does work very well.”