Mher*, 37, has dealt with erectile dysfunction since he was in college. He'd tried Viagra and similar medication but found they didn't help him very much. He saw doctors to help treat the condition but they dismissed his complaints, telling him he was probably dealing with stress or anxiety.
"They brushed off my ED issues as 'being in my head' or 'due to stress,'" Mher told Mic. "They would tell me that I'm healthy and shouldn't have ED at my age."
As a relatively young man, Mher was in the minority of patients with erectile dysfunction, who are predominantly over the age of 50. But he's far from the only young man who's struggled with the condition. According to a 2013 study in the Journal of Sexual Medicine, an estimated one in four patients with new, onset ED are under the age of 40 — yet because we rarely hear about these men, they're left feeling embarrassed and alone.
As one Redditor wrote in a thread posted to /r/sex about his own erectile difficulties, "I'm 26. This shouldn't be happening to me."
Not just for "old men": When most of us think of erectile dysfunction, we think of men in their 60s or 70s, such as former presidential candidate and notorious Viagra spokesperson Bob Dole. The truth is that erectile dysfunction is extremely common among all age groups for various reasons, not all of which are easily identifiable.
Defined as "the inability to get or keep an erection firm enough for sexual intercourse," ED affects nearly 30 million men in the United States (though a 2007 study put the figure at 18 million), according to data from the National Institutes of Health. Doctors have anecdotally reported an increasing number of young male patients; in a recent Vanity Fair piece on hookup culture, writer Nancy Jo Sales spoke with women who noted that many of their Tinder hookups struggle with the condition.
"If a guy can't get hard," one woman told Vanity Fair, "and I have to say, that happens a lot, they just act like it's the end of the world."
In the piece, Sales speculated that ED in young men can be caused by anything from chemicals in processed food to anxiety due to "hookup culture." But while we don't know for sure why young men might develop erectile dysfunction, researchers have identified a few possible causes.
Where it comes from: When talking about erectile dysfunction, it's important to note that while there are many potential causes, they can essentially be divided into two discrete categories: physical and psychological. It's also important to note that there's a huge difference between chronic ED and the occasional (and very normal) inability to maintain an erection during sex.
"When it's persistent and consistent, it's extremely likely to have biological factors" regardless of age, Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego and the director of San Diego Sexual Medicine, told Mic. But the cause of ED can also be psychological: For instance, if a man can get an erection on his own but not with a partner, then his ED is more likely to be rooted in performance anxiety or a deeper psychological issue.
For many older men, issues like diabetes, hypertension and heart attacks are often contributing factors to erectile dysfunction. But Goldstein said that in younger men, ED is far more likely to stem from physical trauma. This could be the result of a sports injury, such as a misplaced karate kick, a surfboard hitting the wrong area or long-distance bike riding. It could also be a result of a sexual injury. (This is most common during heterosexual intercourse, especially in the woman-on-top position, the sex position dubbed "most dangerous" by a 2015 study.)
Additionally, extensive cigarette, alcohol and drug use can play a role, hence the terms "whiskey dick" and, most recently, "weed dick." According to a recent Playboy article by Dr. Justin Lehmiller, a social psychologist at Ball State University and author of the Sex and Psychology blog, recent studies show that erectile dysfunction's prevalence is "three times as high for daily marijuana smokers compared to those who don't use it at all."
A dating death sentence: How men perceive their ED issues also changes with age. With older men, "they've had a life of good erections to look back on," Rose Hartzell, Ph.D., EdS, an AASECT-certified sex therapist with San Diego Sexual Medicine, told Mic. But with some younger men who haven't had much opportunity to be sexually active, "they might feel cheated" out of having a good sex life.
Francis,*, 42, had ED for 11 years before he decided to seek treatment a few years ago. At first, he didn't even realize that he might have ED. "I thought I was either depressed or that I had lost interest in my girlfriend at the time," he said. But when the problem persisted, he realized it was preventing him from having sex with his partner, who often taunted him for struggling to maintain an erection.
This theme of ED carrying over into larger self-esteem issues resonates throughout most narratives of young men with the condition. One gay male Redditor on the subreddit /r/sex wrote that his chronic inability to sustain an erection has ruined both his social and sex lives.
"I feel incredible shame when guys start playing with my dick and I couldn't get hard. Because if this I just avoid hooking up and if I do, I make sure they have no social links to me," he wrote. Even when sex is on the table, he's too ashamed to enjoy it.
If men are single, they often worry about how to broach the topic, given that it's not necessarily easy dinner date conversation.
"How do you tell someone 'I need to use an injection to get an erection?'" said Hartzell.
A solution beyond Viagra: According to Goldstein, young men with ED also have to jump through more hoops to get treatment. That's because for younger patients, doctors tend to assume the ED is either temporary or psychological in nature, which often "leads to bias" and prevents them from getting the care they need and deserve.
"They get [dismissed with] 'Oh gee, it's just in your head,' or 'Find the right woman and it'll all be perfect,'" Goldstein told Mic, echoing the comments of Mher's doctor.
For those who do end up getting treatment, however, there are a number of viable options, which depend less on age and more on the root cause of the ED itself. "The term erectile dysfunction is not a diagnosis. It's a symptom," Goldstein said. "You have dysfunctional erections and you need a diagnosis to find out what the basis is."
If the problem is physical, there are numerous treatments available, such as penile injections or penile revascularization surgery, which increases blood flow to the cavernosal artery of the penis. There are also medications like Viagra, Cialis and Levitra, but Lehmiller cautioned men with erectile difficulties not to self-medicate without seeing a doctor beforehand due to the potential negative side effects associated with such medications (such as chest pain or shortness of breath).
"If you're experiencing erectile difficulties, don't automatically assume that you need Viagra," Lehmiller told Mic. "It may very well be the case that this isn't a physiological problem and it can potentially be resolved in a lot of cases without the need to resort to medication."
How your partner can help: After years of taking Viagra and seeing a psychologist, Mher went to a doctor to get at the root of his ED. As it turned out, he had a blockage in the artery at the base of his penis, which Goldstein was able to treat with arterial bypass surgery.
Now that he no longer has ED, Mher attributed the surgery to helping drastically improve his life. He told Mic that when he was dealing with the condition, most of his partners would eventually break up with him "because they couldn't understand" why he couldn't sustain an erection — a complaint that's common among younger men who struggle with erectile dysfunction.
"It definitely was a blow to my masculinity," Francis told Mic. "It didn't help that my wife at the time would say that I must be gay if I couldn't keep it up for her." Compounding the issue, if an erection doesn't happen during a given sexual encounter, the man can obsess over it, inevitably creating pressure and making it difficult for him to become fully aroused during future encounters.
To avoid such conflicts, Hartzell said she usually meets with both the ED patient and their partner, to emphasize that "it's not his problem, it's their problem," which means they both need to be part of the solution. She says this can be a "mind trip" for those who view erections as the sole measure of a partner's desire for them, as Francis' partner clearly did.
"I like to recommend that couples think outside the box," Dr. Hartzell said. "Intercourse doesn't always have to be the goal; look at sex as pleasure oriented vs. goal oriented." She suggested couples incorporating oral sex and manual stimulation into their bedroom routine. She also advised couples to "have fun" with their sex lives by not adhering to a specific schedule or routine: One woman she works with, for instance, leaves her partner's injection on her pillow as a subtle signal that she's in the mood to have sex.
For Francis, who didn't talk to any of his male friends about it because he didn't think they'd understand, his first piece of advice for fellow ED patients was to know you're not alone.
"There are millions of men out there experiencing the same problems," Francis said. "Don't be afraid to seek medical attention. At first you may be embarrassed to talk about it but once you take action you will be much happier."