When I started my career as a sex therapist in the early 1990’s, erectile dysfunction was an ‘older man’s’ concern. Now, I treat men in their 20’s who can’t get an erection. While the more mature crowd has new-found confidence thanks to Viagra, Levitra, and Cialis, it’s the younger guys who are struggling to perform. What’s going on? Why can’t young men ‘keep it up?’

  1. The Internet & Porn Dependence

In the 1980’s and before, boys typically saw their first naked pictures of women in Playboy Magazine. They knew where their dad or uncle stashed the goods. If they were a true friend, they even stole one to share with their buddies.

If they were really lucky, they ‘struck gold’ by finding something more hardcore, like Penthouse or Hustler. They got the bulk of their sex ed in the locker room and explored masturbation in ‘circle jerks’ around the campfire at Boy Scout campouts.

The Internet changed all that.  American children now begin consuming hardcore pornography at an average age of 11. Witnessing endless combinations of sexual behaviors may leave boys with arousal templates that make it difficult to respond to more conventional, loving sexual interactions.

When you’ve watched anal rape, sex with horses and dogs, enema porn, girl on girl, ‘squirters’, lactation porn, simulated child porn, threesomes, and the ‘money shot’ hundreds (or more likely, thousands of times) by the time you are 14 or 15; ‘vanilla’ sex may lack the flavor you need to achieve and sustain arousal. It will be boring.

When guys rely on porn to have an orgasm, they become extremely efficient at responding to their own touch. I call this Self Stimulation Dependence. They know just how much pressure and speed to use to extend their arousal; and how much to use when they are ready to ejaculate. They become experts at getting themselves off.

Some men expect women to look a certain way, respond a certain way, and be receptive to any and all sexual behaviors. When the reality of sexual inhibition and rigid repertoires come crashing down, it can leave young men without adequate stimulation to get and stay hard.

  1. Alcohol

Another explanation for young male ED stems from alcohol abuse. People drink to take the edge off. And it works. Alcohol has a disinhibiting effect that allows men and women to be more social. There are many young adults who don’t feel comfortable in social situations without a drink in their hand. The problem – alcohol is a depressant. It might provide ‘liquid courage,’ but it is not a friend of the penis. Alcohol undermines sexual function, especially the arousal phase.

Also, it is not uncommon for men to report that they have never had sober sex. They have literally never had sex without being under the influence of alcohol and/or drugs. I’ve treated hundreds of guys in recovery who discover that they can’t keep an erection because it feels too intimate. They don’t know how to relate and be present without hiding behind chemicals. Their emotional and sexual development stopped when they starting partying.

  1. ‘On the Down Low’ or Secret Gender Conflict

Although LGBT rights have come a long way, many guys in their 20’s are still afraid to ‘come out.’ They want a conventional lifestyle. Or they fear their family or religion will disown them if they are openly gay or trans. So they attempt to engage in traditional, conventional sexual relations.

The problem is that their fantasy life does not match their reality. Homoerotic men share that they try to fantasize about having sex with a man but it is not enough. Some trans clients report that they fantasize about being a woman, but the inevitable reality of their biologic male status renders them impotent.

Living a secret life takes a toll not only on one’s sexual function, but also on one’s overall mental health and quality of life. The inability to be authentic can stand in the way of sexual, emotional, and psychological health and satisfaction. A man may feel he can’t be honest, but his penis will speak the truth.

  1. Depression, Anxiety & OCD (and the medications to treat them)

Depression zaps people of energy and vitality. Getting out of bed is a chore. Making it to work is a huge accomplishment. Sexual energy is also undermined by depression. When the future is dark, you feel terrible about yourself, and can barely shower, your sex life (and erectile function) will likely suffer.

Chronic worries can dampen an erection. For the first time in American history, young adults are going to be less successful than their parents. Worries about finances, achievement, and overall success plague many young men. The cultural expectation to be ‘good in bed’ complicates already tenuous self esteem. Performance anxiety can render a man impotent in two seconds flat.

And when you add OCD to the mix, all bets are off. Men with OCD often worry about germs, bodily fluids, and smells. They worry that they have bad breath, or that their penis is too small, or that they will get AIDS. They are overwhelmed with intrusive thoughts, tortured by preoccupying fears, and compelled to engage in rituals that may seem bizarre.

The medications that treat anxiety and depression are a wonderful boon. They enable people who otherwise might be crippled by mental illness to participate in life. However, many of these medications have sexual side effects, which can make getting and staying hard difficult.

Porn dependence, alcohol, being on ‘the down low,’ psych meds, anxiety and depression all affect young men’s penile prowess. So as men in their 60’s, 70’s and 80’s are enjoying sex longer than ever before, young men are struggling to perform. The good news – sex therapy can help.

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