Erectile Dysfunction in the 20s and 30s: What’s Happening in My Prime?
I never actually considered my practice to be an emergency room for men’s sexual health until a man in his mid-20s called and said: “I really need to see you…today! I had a problem down there last night!” Soon after, he sat in front of me, looking exhausted and beside himself and blurted out “I lost my erection during sex for the first time ever! Something’s definitely wrong with me; I hope it’s not serious.” I had him take a few deep breaths and began my investigation into his sexual conundrum.
A Telltale Sign
It’s now clear that ED is the “canary in the coalmine” for cardiovascular disease. This concept was really driven home by the finding that men with significant ED in their 40s had 2-3x the risk of having significant cardiovascular events (heart attack or stroke) with age. This risk was the same as that incurred by having a significant smoking history. But the root cause of ED-heart disease link is not as simple as you might think. The most obvious explanation is that arterial plaques that cause heart attacks affect arteries in penis first, as penile arteries are smaller than coronary arteries. But that’s not what’s happening. Instead, it appears to be a generalized “hardening of the arteries” issue in the entire circulatory system that doesn’t involve plaques, but dysfunction of endothelial cells that line all blood vessels. Either way, the penis is a harbinger of heart disease.
Is impending heart disease a concern in this young man with his first failed erection? No. On further questioning, he was an otherwise healthy man who was leading a startup and working insane hours, traveling constantly, sleeping sparingly, and eating sporadically. When combined, these factors deliver an enormous punch of stress to the body. And how does the body respond to stress? Well, it turns on the sympathetic nervous system, the same one that helped us as cavemen to run for our lives when being chased by woolly mammoths. Who wants an erection when you’re running for your life? After the interview, I told him: “Welcome to humanity; now think about reducing your stress.”
What’s Chasing You?
The most common causes of erectile dysfunction in young men are not impending heart disease, but sheer physical, emotional, financial and travel stress. To boot, lack of sleep, poor energy balance from bad eating habits and use of recreational drugs like alcohol and pot all contribute to the problem. Could there be a heart disease or testosterone issue present? Absolutely, in 5-10% of cases, but that’s what doctors like me are for: to figure all of this out.
It was none other than Leonardo da Vinci who first noted in the 15th century that “the penis does not obey the order of its master… The penis must be said to have its own mind, by any stretch of the imagination.”