Erectile Dysfunction in Young Men: Why It Happens and What Actually Helps

In this guide

• How common it really is when you are young
• Why it happens: the head, the body and the lifestyle
• The porn question, answered honestly
• What actually helps, in the order I would try it
• When to see a doctor, and what they will do

There is a message I get almost every week, and it nearly always comes from a man in his twenties or early thirties. The details change, but the shape is the same: I am young, I am fit, I am attracted to her, and it just did not work. What is wrong with me?

I want to answer that properly, because the silence around this subject does more damage than the problem itself. Men assume erection trouble is something that happens to sixty-year-olds. When it happens to them at twenty-six, they panic, they google at 3 a.m., they buy something dubious online, and they avoid sex for months. That avoidance makes everything worse.

My job depends on my body working on schedule, under lights, with a crew watching. I know very well what it is like when the head and the body stop cooperating. So let me tell you what the evidence says, and what I have learned about getting them back on the same side.

How common is it, really?

The NHS describes erectile dysfunction as very common, especially in men over 40, and is clear that occasional problems are usually nothing to worry about. Stress, tiredness, anxiety or drinking too much can all cause a one-off failure (NHS: Erection problems).

What surprises people is how often persistent ED shows up in young men. An Italian study published in the Journal of Sexual Medicine looked at men attending an outpatient clinic for newly diagnosed erectile dysfunction. About one in four was under 40, and almost half of those younger men had severe ED, a rate similar to the older men in the study (Capogrosso et al., 2013).

That does not mean one in four young men has ED. It means that among men walking into a clinic with the problem, young men are not the exception people think they are. You are not a medical curiosity. You are a fairly ordinary patient.

Erection trouble is not an old man’s problem. In one clinic, one in four new patients was under 40. You are not a curiosity; you are a normal patient.

Why it happens: three buckets

Doctors usually think about causes in three overlapping groups. Mayo Clinic describes male sexual arousal as a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels, and says a problem in any of them can cause ED, often in combination (Mayo Clinic: Erectile dysfunction).

1. The head

In younger men this is very often part of the story. The NHS lists stress, anxiety, depression and relationship problems among the common causes. And there is a nasty loop here: one bad night makes you anxious about the next one, the anxiety floods your body with stress hormones, and stress is the enemy of an erection. Then it fails again, and now you have “proof”.

I have written a full piece on sexual performance anxiety, because it deserves its own space. The short version: an erection is a relaxation response. You cannot force it, and the harder you try, the less it cooperates.

2. The body

Young does not automatically mean healthy. An erection is, at its core, a blood-flow event, so anything that damages blood vessels or nerves can affect it: high blood pressure, high cholesterol, diabetes, obesity, and some hormone problems. Certain medicines are also on the NHS list, including some antidepressants and blood pressure drugs. Never stop a prescribed medicine on your own; talk to the doctor who prescribed it.

This is where the most important fact in this article lives. A large analysis of men in the placebo group of a prostate cancer prevention trial found that men with erectile dysfunction had a higher risk of later cardiovascular events, and the authors suggested ED should prompt a look at heart risk (Thompson et al., 2005). The arteries in the penis are small, so they can show problems earlier than the bigger ones around the heart. Your erection can be an early warning light.

3. The lifestyle

This is the bucket young men have the most control over:

• Smoking damages blood vessels. The NHS lists it as a cause, and quitting is one of the best things you can do for your erections (NHS: Quit smoking).
• Alcohol. One or two drinks may relax you. A heavy night is one of the most reliable ways to fail.
• Recreational drugs, including cocaine and, for some men, cannabis, are on the NHS list.
• Sleep. Exhausted bodies do not perform. In a small but well-known study, healthy young men restricted to five hours of sleep for one week had lower daytime testosterone (Leproult & Van Cauter, 2011).
• Weight and fitness. In a randomised trial in JAMA, obese men with ED who lost weight and exercised more improved their erectile function compared with controls (Esposito et al., 2004).

The porn question

I work in porn, so I will be honest rather than defensive. The research on “porn-induced erectile dysfunction” is mixed, and I am not going to claim it is proven or disproven. What I can tell you from common sense and from talking to a lot of men is this: if your only sexual routine is fast masturbation to an endless stream of new, extreme videos, a real partner in a dim room can feel like a very different stimulus. Some men find that a break, or simply slowing down and paying attention to their own body when they masturbate, helps.

What I would not do is decide on your own that porn is the whole explanation and skip the doctor. Blaming the screen is comfortable. Missing high blood pressure is not.

What actually helps, in the order I would try it

Step 1: Take the pressure off

The single most useful thing is to stop treating every sexual encounter as an exam. Tell your partner something simple, like “I’ve been stressed and my body has been weird, let’s go slow.” Most partners respond to honesty far better than to a man who goes silent and avoids them.

Then widen the definition of sex. Hands, mouth, kissing, touching, time. When penetration is not the only goal, the panic switch has less to grab onto. Many men find the erection returns precisely when they stop demanding it.

Step 2: Fix the basics for six weeks

• Cut alcohol right down, especially before sex.
• If you smoke or vape nicotine, start quitting.
• Sleep seven hours or more.
• Move every day. The NHS recommends at least 150 minutes of moderate activity a week (NHS: Exercise).
• Train your pelvic floor. I explain how in my guide to lasting longer in bed.
• Eat better. I wrote about what the research says on diet and erections.

Step 3: See a doctor, especially if it is persistent

If it has been going on for a few weeks or more, or it is happening most of the time, book an appointment. The NHS says a GP can usually help, and you can also go to a sexual health clinic. Mayo Clinic notes that doctors will typically ask about your health and sexual history, do a physical exam, and may order blood tests to check for things like diabetes, heart disease, low testosterone and other conditions (Mayo Clinic: ED diagnosis and treatment).

A useful clue doctors often ask about: do you still get erections in the morning or when masturbating? If yes, the plumbing is probably working and the cause may be more psychological or situational. That is not a diagnosis; it is a conversation to have with a professional.

Step 4: Treatments that exist

The NHS and Mayo Clinic describe a range of options:

• Medicines like sildenafil and tadalafil, which help blood flow when you are aroused. They do not create desire, and they are not safe for everyone, especially men taking nitrates for heart problems.
• Talking therapies, such as psychosexual counselling or cognitive behavioural therapy, when anxiety, depression or relationship problems are involved (NHS: CBT).
• Treating the underlying condition, such as blood pressure, diabetes or a hormone problem.
• Other options, such as vacuum pumps, for men who cannot use or do not respond to tablets.

Please do not buy “herbal Viagra” from random websites. Regulators around the world regularly find undeclared prescription drugs in so-called natural sexual supplements. If you are going to take something, take something a doctor or pharmacist has checked for you.

What I want you to remember

If it happened once, it is not a condition, it is a night. Breathe, laugh about it if you can, and do not let one failure write the story of the next ten.

If it keeps happening, it is information. Sometimes that information is “you are stressed and sleeping five hours.” Sometimes it is “check your blood pressure.” Either way, the man who goes to the doctor at 27 is doing something smart, not something shameful.

None of this is medical advice. I am a performer, not a physician. These are the sources I trust and the habits that keep my own body working.

If you are curious about who I am and what I do, everything official is on maximogarciaworld.com, and the explicit side of my work lives on fuckingpornstars.net (18+ only). For more straight talk from inside the industry, read is porn real? What happens behind the scenes, and if you want the confidence side of the story, my piece on how to be confident with women on House of Maximo is a good next read.

Sources

1. NHS. Erection problems (erectile dysfunction).
2. Mayo Clinic. Erectile dysfunction: symptoms and causes.
3. Mayo Clinic. Erectile dysfunction: diagnosis and treatment.
4. Capogrosso P et al. One patient out of four with newly diagnosed erectile dysfunction is a young man. J Sex Med, 2013.
5. Thompson IM et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA, 2005.
6. Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 2011.
7. Esposito K et al. Effect of lifestyle changes on erectile dysfunction in obese men. JAMA, 2004.
8. NHS. Quit smoking.
9. NHS. Exercise guidelines for adults.
10. NHS. Cognitive behavioural therapy (CBT).