Q:

I have been having problems during sex with keeping and some times getting an erection. I feel this shouldn't be an issue yet because I'm in my midtwentys and extremely healthy. What are some things that might cause this and or things I might be able to do to help this not happen for me?

 

A:

There are a host of reasons that may cause erectile dysfunction.  Here is a list of many of them that may be involved, either alone or in combination:

 

Psychogenic:

“Performance anxiety”: doubts about ability to function sexually, or even experiencing a single episode of failure or “inadequate” function, can cause long-lasting erectile problems

Relationship conflicts with a sexual partner can inhibit function

Depression, anxiety, stress or other psychological disorders

 

Substance-related:

Alcohol use: even small quantities can disturb erectile function

Substance abuse: cigarette smoking, marijuana use, cocaine use

Prescribed medications: blood pressure medications, diuretics, antidepressants, tranquilizers, seizure medications, antihistamines, nonsteroidal anti-inflammatories (such as ibuprofen, naproxen and others), muscle relaxants, anti-ulcer medications, medicines for prostate cancer and other cancer chemotherapy drugs, medicines to control heart rhythm defects, cholesterol-lowering drugs, and probably others.

 

Organic (physical causes):

Endocrine (hormonal): hyperthyroidism, hypothyroidism, hypogonadism (low testosterone), pituitary gland abnormalities, diabetes mellitus

Neurologic: central and peripheral nervous system diseases, surgical damage to nerves such as in prostate removal for cancer, repetitive trauma such as from prolonged cycling on hard saddle

Blood vessel problems: hardening of the arteries, high blood pressure, elevated cholesterol, penile vascular malformations.

Systemic diseases: kidney failure, liver disease, scleroderma, lung disease, malnutrition

 

Being “young” does not rule out any of the above possible causes for erectile dysfunction.  The above are listed in the approximate order of likelihood for a 20-30 year old male.  As one ages, organic causes, especially blood vessel problems, become increasingly likely as causes of erectile dysfunction.

Since there are so many potential causes, it is important for a person with erectile dysfunction that persists (the usual criterion is that symptoms persist for a minimum of 3-6 months) to consult his health care provider so that the specifics of his problem can be sorted out.  Once a diagnosis of the cause is made, effective treatment can usually be instituted.

~The Doc