Dear Dr G,

I am a college student who just turned 22 and I am at the peak of my life.

I am also in a sexual relationship in college with this girl I met.

One thing I noticed, and terrifies me, is the occasional inability to perform between the sheets.

There is no real specific trigger for me to end up with a soft erection, I guess I can always blame it on the stress of my academic (and party life) in college.

I noticed that my weak erection is getting more common in recent weeks, despite being on holidays, away from all the stresses of life.

Overall, I am a healthy individual. Besides the occasional alcoholic drink and cigarette, I am slightly on the heavy side for bodily weight.

Therefore, it prompted me to put Dr. G on the spot to identify the causes of my failure to perform, despite the peak of my youth.

Firstly, what constitutes erectile dysfunction?

What are the causes of ED? Are the causes mainly psychological?

How common is ED? And how common does ED affect youth?

Do young men really get erectile dysfunction? Isn’t that an old man’s disease?

Finally, I am determined not to get ED, can you tell me the way to prevent this horrible condition?

Regards

Youthful Yong

Erectile dysfunction, or ED, is defined as the inability to achieve or maintain an erection for satisfactory sexual intercourse. Before the turn of the century, ED is also derogatively called impotency, causing shame and embarrassment for men to discuss the subject. Despite having more disease awareness in the public arena and effective treatments, erectile dysfunction remains a taboo subject in many societies.

ED is a common sexual dysfunction and is estimated to affect 18 million American men. In some studies, ED is reported to have a prevalence of up to 52%.

Although most of the affected men are older, ED can also affect the younger generations of men. Occasional “hiccups” is very common in young men, however, persistent failure to perform is generally abnormal. Malaysia Health and Morbidity Survey published in 2019 revealed three in ten men suffer from ED in our country. Although not surprising more than sixty per cent of men above the age of sixty reported the sexual dysfunction, the shocking finding is that ED also affected more than 36.9% of men aged 18 to 29 years old.

The causes of ED amongst youth may be associated with the rising non-communicable diseases that are also on the rise in younger men. These include hypertension, dyslipidemia, diabetes, obesity and depression. Other causes of ED also include side effects of medicine, alcohol and smoking. In fact, ED is three times more likely to affect diabetic men, two times more likely in hypertensive men, twice more likely in men with high cholesterol, and twice more likely to affect men who smoke and drink. In addition, nearly 80% of obese men are also likely to be affected by ED. And all these non-communicable diseases are on the rise amongst youth.

Stress and anxiety were thought to be the main etiology of erectile dysfunction, however other causes are thought to be equal or more important factors. The normal physiology of an erection is quite straightforward. The arousal in the brain is influenced by the male hormone, testosterone. This in turn will generate the stimulation of the blood vessels and nervous systems. The combination of both will subsequently induce an erectile rigidity that will be ready for sexual activity. The emotional state of mind can also adversely affect sexual functions, despite perfectly functioning brain, blood vessels, nerves and hormones.

Stress and anxiety can produce the enhanced circulation of adrenaline, which is the complete antidote for a normal erection. Unfortunately, stress and ED are also a vicious cycle that often spiral out of control. It is also important to understand that stress is the body’s response to life’s issues; these may include relationships, fear of infections, sexuality, body image and performance expectations.

The challenges faced by youth these days cannot be undermined, especially in the era of the Covid-19 pandemic. The scientific data revealed that stress and anxiety during the pandemic can cause ED in up to 10% of men who do not suffer from ED. The figure can be three times higher if an individual is infected with Covid-19, which may be associated with the inflammatory changes that can further affect the normal physiology of sexual functions.

There is no question the challenges faced by the youth these days are mounting. Apart from more stress and anxiety in the modern digital world, data also reveals a declining state of health amongst youth. The silver lining is that an open discussion on sexual health is less of a taboo these days. Moreover, the effectiveness of the blue pills is also making ED less of a “hard’ issue to get it “hard”. Early health interventions are the key to ensuring better sexual health and overall health.

Therefore, in many ways, preventive measures are also the cure for ED. Baron Stanislaw Jerzy Lec, the Polish aphorist and poet once said: “Youth is a gift of nature, but age is a work of art.” Young men with unexpected ED often put Dr. G on the spot for a cure for ED. His response is: “Youth is a gift of nature because of the state of health, healthy preventive aging is definitely the cure to ensure the perfect work of art!”

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