Organic Causes of Erectile Dysfunction in Men Under 40

Abstract

There are a significant number of men under 40 who experience erectile dysfunction (ED). In the past, the vast majority of cases were thought to be psychogenic in nature. Studies have identified organic etiologies in 15-72% of men with ED under 40. Organic etiologies include vascular, neurogenic, Peyronie's disease (PD), medication side effects and endocrinologic sources. Vascular causes are commonly due to focal arterial occlusive disease. Young men with multiple sclerosis, epilepsy and trauma in close proximity to the spinal cord are at increased risk of ED. It is estimated that 8% of men with PD are under 40, with 21% of these individuals experiencing ED. Medications causing ED include antidepressants, NSAIDs and finasteride (Propecia), antiepileptics and neuroleptics. Hormonal sources are uncommon in the young population, however possible etiologies include Klinefelter's syndrome, congenital hypogonadotropic hypogonadism, and acquired hypogonadotropic hypogonadism. The workup of young men with ED should include a thorough history and physical examination. The significant prevalence of vascular etiologies of ED in young men should prompt consideration of nocturnal penile tumescence testing and penile Doppler ultrasound. Treatment options that may improve ED include exercise and oral PDE-5 inhibitors.

Erectile dysfunction

“…Despite being studied thoroughly in men over 40 years of age 18 , the prevalence of erectile dysfunction in younger men is rarely regarded as interesting 19,20 . In this context, a recent naturalistic study (a study in which the participant is observed without any manipulation by the researcher) reported that one man out of four seeking medical help for erectile dysfunction in the real-life setting is <40 years of age 21 .…”

“…However, these factors should not disregard the importance of the components of distress and discomfort that are brought by the onset and persistence of erectile dysfunction and by problems related to sexuality. Such components include anxiety and alexithymia (lack of emotional awareness) and even the possibility that, perhaps especially in younger patients, erectile dysfunction can be both a symptom and a sentinel marker of serious organic problems 20,23–26 .…”

Erectile Dysfunction Treatment Using Focused Linear Low-Intensity Extracorporeal Shockwaves: Single-Blind, Sham-Controlled, Randomized Clinical Trial

“…Many cases of ED are or-ganic in origin, including vascular, neurogenic, hormonal, or due to medication side effect. It is the significant prevalence of vascular etiology of ED in young men [3]. Vasculogenic ED is the most common risk factor for ED, with a high prevalence (40%) in men with a high cardiovascular risk [4].…”

Effectiveness of Phosphodiesterase 5 Inhibitors in the Treatment of Erectile Dysfunction in Patients with Spinal Cord Trauma: Systematic Review and Meta-Analysis

“…In the United States, the annual incidence and the prevalence are estimated between 130 and 1,124 cases per million people and 11.5-53.9%, respectively [2] , and it is one of the most important causes of erectile dysfunction in men under 40 years [3] . SCI constitutes an absolute limitation for the development of sexuality, erection and fertility.…”

“…It is now considered that the lack of sexual motivation is associated with social isolation and limitation for rehabilitation. Sixty-six percent of patients with spinal cord trauma consider their erection sufficient to perform sexual intercourse, although both men and women report low fre-quency sexual activity [1,3] . In men with complete SCI, more than 80% can achieve erection, whether reflexogenic, psychogenic or mixed; however, most of them require some kind of treatment for erectile dysfunction.…”