Erectile dysfunction affects 30 million people in the United States. The problem can occur at any age, but the older a person gets, the greater the chance of developing a health problem that results in ED. According to the National Institutes of Health, among people with penises, approximately 5% of 40-year-olds and between 15 and 25% of 65-year-olds experience ED on a long-term basis.

In young people, erectile dysfunction is less common and when it does occur is more likely to have a psychological cause such as stress or performance anxiety. Still, younger people are seeking treatment for this and other sexual problems in increasing numbers. The use of Viagra increased 312% among people aged 18-45 between 1998 and 2002.

While thoughts and emotions always play a role in getting an erection, erectile dysfunction is most often caused by something physical, such as a chronic health problem or the side effects of a medication. The physical and psychological causes of erectile dysfunction interact. For instance, a minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The resulting anxiety can worsen erectile dysfunction.

A variety of physical risk factors can contribute to erectile dysfunction. Factors that may be present for younger men include:

Substance abuse. Chronic use of alcohol, cannabis or other drugs can cause erectile dysfunction and decreased sexual drive.

Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.

Smoking. Smoking can cause erectile dysfunction because it restricts blood flow to veins and arteries. People who smoke cigarettes are much more likely to develop erectile dysfunction.

Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some people, erectile dysfunction may be caused by low levels of testosterone.

Taking certain medications. A wide range of drugs - including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer - can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem.

Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.

Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness.

Metabolic syndrome. This syndrome is characterized by unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance. 

Although most people with penises experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:

• Exercise regularly.

• Reduce stress. Click to learn more about stress management.

• Get enough sleep. Click for healthy sleep tips.

• Get help for anxiety or depression.

• Limit or avoid the use of alcohol.

• Avoid recreational drugs, including cannabis.

• Stop or reduce smoking. Access smoking cessation strategies and support here.

• See your medical provider for regular checkups and medical screening tests.

• Work with your medical provider to manage conditions that can lead to erectile dysfunction, such as diabetes and heart disease.

For psychological causes, seeking treatment from a mental health professional or from a sex therapist can be very helpful. If you are a Brown student, you can seek help from Counseling and Psychological Services for issues including stress, depression, and anxiety. AASECT maintains a list of certified sex therapists across the country.

For physical causes, a wide variety of treatments are available, depending on the specific physical issue. The first step is often to try ED medications, like Viagra, since these help most men. Depending on your diagnosis, other treatments range from changing your prescription drugs to hormone replacement therapy, antidepressant therapy, and devices, medications or implants to produce erections. 

Many people with penises sometimes ejaculate sooner than they or their partner would like. If it just happens occasionally, it's probably not something to worry about. However, if you regularly ejaculate sooner than you and your partner would like, such as before intercourse begins or soon afterward, you may have a condition known as premature ejaculation. Although the issue is often phrased in terms of time (i.e., I'm ejaculating within thirty seconds after starting intercourse), the issue is really about voluntary control of the ejaculatory process. 

Premature ejaculation can have both psychological and biological causes.

Psychological causes

• Early sexual experiences may establish a pattern which is difficult to change. First experiences of sexual intercourse often involve excitement mixed with anxiety and a demand to perform quickly in order to avoid being discovered. Your focus might be on your performance rather than on the pleasurable and erotic aspects of the experience. Most people with penises reach orgasm very quickly the first time they have intercourse. Although most will also learn to slow down, to enjoy their own and their partner's pleasure, and become comfortable and confident with sexual intercourse, early ejaculation continues to be a problem for about 30 percent of people with penises.

• Many people with premature ejaculation also have problems with anxiety - either specifically about sexual performance, or anxiety caused by other issues. In general, linking sex and performance, rather than sex and pleasure, can be problematic. In developing ejaculatory control, you might find that it is best to focus on what would bring pleasure to you and to your partner. It can also help to think of ejaculatory control as a skill that you and your partner develop together to enhance mutual satisfaction.

• Premature ejaculation can also be related to erectile dysfunction. People who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate and have difficulty changing that pattern.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

• Abnormal hormone levels

• Insufficient concentration of the neurotransmitter serotonin

• Abnormal reflex activity of the ejaculatory system

• Certain thyroid problems

• Inflammation and infection of the prostate or urethra

• Inherited traits

Rarely, premature ejaculation is caused by:

• Nervous system damage resulting from surgery or trauma

• Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems

Whether the cause is psychological or biological, treatments including medications, counseling and learning sexual techniques to delay ejaculation can improve sex for you and your partner(s). 

Treatment for premature ejaculation can include behavioral therapy (including learning specific sexual techniques), certain medications and counseling or psychotherapy. Often, a combination approach works best. 80-90% of people experiencing premature ejaculation are able to learn better control through treatment.

In some cases, behavioral therapy may involve simple steps such as masturbating an hour or two before intercourse to help you delay ejaculation during sex or stimulating your partner to a state of high arousal before you have your genitals touched, so that your orgasms can be achieved closer to the same time.

Another approach that may help is to avoid intercourse for a period of time and instead focus on other types of sexual play so that pressure is removed from your sexual encounters. Connecting in this way can help you re-establish a satisfying physical bond with your partner(s).

In addition to the approaches above, there are two specific behavioral methods which can help you develop ejaculatory control:

• The stop and start method helps you learn to recognize when climax is imminent and to slow down or reduce stimulation in order to extend the time until ejaculation. If you find yourself nearing climax, withdraw your penis from your partner or otherwise reduce stimulation and allow yourself to relax enough to prevent ejaculation. By starting and stopping sexual stimulation and learning to notice when climax is imminent, you can learn to prolong the sex act.

• A second method known as the squeeze technique also helps you gain control over the timing of your ejaculation. To use the squeeze technique, you begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Have your partner squeeze the end of your penis, at the point where the head joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. After the squeeze is released, wait for about 30 seconds, then go back to sex play. (You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, the full erection returns.) If you again feel you're about to ejaculate, have your partner repeat the squeeze process. By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. You can also use this technique without a partner by masturbating and then applying the squeeze yourself as described above. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medication is another option for treatment and generally most effective when used in combination with behavioral methods. Certain antidepressants and topical anesthetics can be used to treat premature ejaculation. You may need to try different medications or doses before you and your doctor find a treatment that works for you.

A side effect of certain antidepressants is delayed orgasm. Doctors sometimes suggest people who are experiencing premature ejaculation can take antidepressants to benefit from this specific side effect. You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Desensitizing lubricants can also be used to treat premature ejaculation. They contain a mild anesthetic (7.5 percent benzocaine) that causes a temporary numbing sensation after being applied to the skin. The purpose of this desensitization is to help men to keep their erections and to postpone ejaculation. Since the penis has less sensation, sexual pleasure could be reduced. Wearing a condom when you use these products can help so that the lube can't rub off onto your partner's body, diminishing sensation and pleasure for them as well. Desensitizing lubes are water-soluble, not oil-based, and so they can be used with latex condoms. They are available over the counter. Durex Play Longer is one of the most commonly available desensitizing lubes.

If you suspect that the main cause of your premature ejaculation is anxiety, meeting with a mental health professional to address this issue can be an essential step in treating the problem. If you are a Brown student, you can make an appointment with Counseling and Psychological Services by calling 401.863-3476.