Concerns About Erectile Dysfunction in Young Men: Seeking Guidance

I'm a bit worried..?

Hello Doctor, I am 21 years old.
Three years ago, I underwent surgery for varicocele (left lower abdomen).
About six months ago, I noticed that my erectile function has not been as good as before (not as firm).
At that time, I thought it might be due to stress from various personal matters, so I didn't pay much attention to it.
I tend to be a very anxious person who puts a lot of pressure on myself and often overthinks things.
However, I later realized that for quite a while (up to now), I have not experienced morning erections after waking up, and when I try to stimulate myself, the hardness of my penis is poor, and I ejaculate very quickly.
What worries me even more is that I find it difficult to achieve an erection through fantasy; I need to rely on manual stimulation.
Moreover, once the penis becomes engorged, if I stop the stimulation, it quickly subsides.
This situation has been ongoing for more than two to three months.
Doctor, could you please advise me on what problems I might have? I live in Changhua City; do you have any recommended doctors for me to consult? Thank you for taking the time to respond to a very concerned young man.

skylark, 20~29 year old female. Ask Date: 2004/11/17

Dr. Xu Weikai reply Urology

Hello, your situation is actually something many young people encounter, especially newlywed couples.
It is usually caused by psychological issues such as work stress, parenting, and financial concerns.
To elaborate, during youth, insufficient sexual experience combined with heightened sensitivity can indeed lead to premature ejaculation; however, this tends to improve gradually with experience.
Regarding the other issue you mentioned about erectile firmness, I recommend that you consult a urologist nearby to determine whether there is a genuine issue with erectile function or if your expectations are simply higher.
Generally, larger hospitals (such as National Taiwan University Hospital, Veterans General Hospital, Shin Kong Wu Ho-Su Memorial Hospital, and Mackay Memorial Hospital) have the equipment to test erectile rigidity and endurance, so you can choose one for your consultation.
Sincerely, Dr.
Hsu Wei-Kai, Head of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2004/11/17

More Info

Erectile dysfunction (ED) in young men is a concern that is becoming increasingly common, and it can stem from a variety of factors, both psychological and physiological. Based on your description, it seems you are experiencing several symptoms that could indicate a form of erectile dysfunction. Let's break down your concerns and provide some insights.

1. Erectile Dysfunction at a Young Age: It is indeed possible for a 21-year-old to experience erectile dysfunction. While it is more commonly associated with older age, younger men can also face this issue due to various reasons, including psychological stress, anxiety, or even physical factors such as hormonal imbalances or vascular issues. Your history of surgery for varicocele (enlarged veins in the scrotum) could also play a role in your current symptoms, as it may affect blood flow and hormone levels.

2. Morning Erections: The absence of morning erections, which are typically a sign of healthy erectile function, can be concerning. Morning erections are influenced by testosterone levels and overall vascular health. If you are not experiencing these, it could indicate a potential hormonal issue or a problem with blood flow.

3. Psychological Factors: You mentioned that you are prone to anxiety and stress, which can significantly impact sexual performance. Psychological factors are often the leading cause of erectile dysfunction in younger men. Performance anxiety, stress from daily life, or even the pressure you put on yourself can lead to a cycle of anxiety that exacerbates the problem. It’s essential to address these psychological aspects, possibly with the help of a mental health professional or a sex therapist.

4. Physical Factors: The quick loss of erection after stimulation and the difficulty in achieving an erection without manual stimulation could suggest that there may be physical factors at play. This could include issues with blood flow, nerve function, or hormonal levels. It might be beneficial to undergo a thorough medical evaluation, including blood tests to check testosterone levels and other relevant hormones, as well as a physical examination to assess any potential vascular issues.

5. Seeking Medical Help: Given your ongoing symptoms, it would be wise to consult a urologist who specializes in sexual health. They can provide a comprehensive evaluation and may recommend tests such as a penile Doppler ultrasound to assess blood flow or other diagnostic procedures to determine the underlying cause of your erectile dysfunction.

6. Lifestyle Considerations: In addition to seeking medical advice, consider lifestyle changes that can improve your overall health and potentially alleviate some of your symptoms. Regular exercise, a balanced diet, adequate sleep, and stress management techniques such as mindfulness or yoga can all contribute positively to sexual health.

7. Communication: If you are in a relationship, communicating openly with your partner about your concerns can also help reduce anxiety and improve intimacy, which may alleviate some of the psychological barriers you are facing.

In conclusion, while it is understandable to be concerned about your erectile function at a young age, it is important to remember that many factors can contribute to this issue. Seeking professional help is crucial for a proper diagnosis and treatment plan. You are not alone in this, and many young men experience similar challenges. Addressing both the psychological and physical aspects of your situation will be key to finding a resolution.

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