Erectile Dysfunction: Causes and Concerns for Young Men

Does this indicate a problem with sexual function?

Hello, Dr.
Hsu: I am 28 years old, and I have noticed that my sexual function has not been normal for the past six months.
1.
I have found that after achieving an erection, if there is no stimulation, it quickly (within 20 seconds) subsides.
When changing positions during intercourse, if I am not stimulated for less than 20 seconds, I become flaccid to the point where penetration is not possible, and I need to be stimulated again to achieve an erection.
2.
Most of the time when I wake up in the morning, I do not have an erection; even if I do, it is only a slight increase in size of the penis.
3.
The angle of my erection is at most parallel to the ground; I have heard it should point upwards? I am very worried; is there something wrong? Do I need to undergo further detailed examinations? Could it be a case of venous leakage? Previously, I had some tests done due to scrotal swelling and pain, and I was diagnosed with varicocele, which is quite severe.
Could the varicocele be affecting the issues I mentioned above?

Wuming, 20~29 year old female. Ask Date: 2008/12/16

Dr. Xu Weikai reply Urology

Hello, it sounds like you need to undergo further diagnostic evaluations, such as penile pressure measurements, an erection test, and blood tests for hormone levels.
You may need to visit a medical center to access a full range of equipment.
Severe varicocele can affect testicular development, leading to decreased sperm production capacity, and it may sometimes impact sexual function, although this is not common.
If there are any unclear points, feel free to ask again, and we can discuss and research further.

Sincerely,
Dr.
Hsu Wei-Kai
Department of Urology
Taitung Hospital, Department of Health, Executive Yuan

Reply Date: 2008/12/16

More Info

Erectile dysfunction (ED) in young men is a growing concern, and your situation reflects a common issue that many face. At 28 years old, experiencing difficulties with erections can be distressing, especially when it affects your sexual performance and overall confidence. Let's break down your concerns and explore the potential causes and solutions.

1. Erection Duration and Quality: You mentioned that your erections quickly fade without stimulation, which is a classic sign of erectile dysfunction. This can be attributed to various factors, including psychological stress, anxiety, or even physical conditions. The fact that you require continuous stimulation to maintain an erection suggests that there might be an underlying issue that needs addressing. It's essential to consider both psychological factors (like anxiety about performance) and physiological factors (such as blood flow issues).

2. Morning Erections: The absence of morning erections can be indicative of a problem. Typically, men experience several erections during sleep, known as nocturnal penile tumescence. If you're not experiencing this, it could suggest a physiological issue rather than a purely psychological one. However, it's important to note that lifestyle factors, stress, and fatigue can also play a significant role in this.

3. Erection Angle: The angle of your erection is another concern. While variations exist, a significant deviation from the norm could indicate a physical issue. Erections that are not firm enough to penetrate, or that do not point upwards, can be a sign of vascular issues or other anatomical problems.
4. Potential Causes: Given your history of varicocele (enlarged veins in the scrotum), it's possible that this condition could be contributing to your erectile dysfunction. Varicoceles can affect testosterone levels and blood flow, which are crucial for achieving and maintaining an erection. Additionally, conditions like venous leakage (where blood flows into the penis but does not remain there) can also lead to difficulties in maintaining an erection.

5. Next Steps: It is advisable to seek a thorough evaluation from a urologist. They may recommend tests such as a Doppler ultrasound to assess blood flow to the penis, hormone level tests to check testosterone, and possibly a nocturnal penile tumescence test to evaluate your erections during sleep. Understanding the root cause of your erectile dysfunction is crucial for effective treatment.

6. Psychological Factors: Don't underestimate the impact of psychological factors. Stress, anxiety, and performance pressure can significantly affect sexual function. Consider speaking with a mental health professional or a sex therapist who can help you work through any anxiety or stress related to sexual performance.

7. Lifestyle Modifications: In addition to medical evaluation, consider making lifestyle changes that can improve your overall health and potentially your erectile function. Regular exercise, a balanced diet, adequate sleep, and stress management techniques (like mindfulness or yoga) can all contribute positively.

In conclusion, while your symptoms are concerning, they are not uncommon among young men. The combination of psychological and physiological factors often plays a role in erectile dysfunction. Seeking professional help is the best course of action to determine the underlying causes and to explore appropriate treatment options. Remember, you are not alone in this, and many men experience similar issues at various points in their lives.

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