Erectile dysfunction (ED) is the most commonly reported sex problem among men. In fact, it’s estimated that some 30 million men in this country are affected by ED, which is also sometimes referred to as impotence. Medically, it’s defined as the inability to get or maintain an erection that is firm enough for sex.
While the risk of ED increases with age, it can—and does—happen to young men. But there are steps you can take to reverse ED and prevent it from becoming a problem.
“Getting an erection is primarily a hemodynamic event,” explains John Valvo, MD, urologist at Rochester Regional Health and senior partner at the Center for Urology in Rochester, New York. “You need intact vascular, hormonal, and neurological systems, with a psychological overplay. As long as those systems are functioning and not interfered with by disease or medications, one should expect a normal sexual response. Certainly, men in their 80s and 90s are likely going to be impacted by ED. But it’s not normal in young men, and it shouldn’t be something that’s accepted.”
At what age does erectile dysfunction start?
There isn’t an official “erectile dysfunction age,” but erection problems like ED mainly affect men over 40, with prevalence increasing with age.
- 17% of men age 40–49 had ED
- 30%–35% of men age 50–59 had ED
- 68% of men 60–69 had ED
- 83% of men 70 and older had ED
One of the main reasons older men are more likely to have ED than their younger counterparts is because they’re more likely to have health problems that can impact things like blood flow to the penis (essential for an erection) and nerve functioning.
Risk factors for ED
Some of the ED risk factors seen more commonly in older men are:
- Diabetes: It’s been estimated that 35%–50% of men with diabetes have ED. That’s often due to the fact that diabetes can harden the arteries (called atherosclerosis) impairing blood flow and interfering with the nerves that help create and maintain erections.
- High blood pressure (aka hypertension): Sixty-one percent of men with high blood pressure have reported experiencing ED.
- Kidney disease: Kidneys that aren’t in good working order can impact nerve functioning, energy levels, and the hormones that circulate in our bodies. And when those things falter, erections can suffer.
- Cardiovascular disease: According to Johns Hopkins Medicine, one of the earliest signs of heart disease is the inability of blood vessels in the penis to enlarge, allowing enough blood flow to get and maintain an erection. One study looking at racially diverse men with an average age of 69 and no prior history of heart disease found that 46% had ED. At the end of the four-year study, researchers found that those men with ED had over twice the number of heart attacks, cardiac arrests, and strokes than the men without ED.
- Prostate disease: The prostate is a small gland that lies between the penis and the bladder. Some of the therapies (certain drugs, surgery) that are used to treat an enlarged prostate and prostate cancer can cause ED.
- Obesity: One study found that 73% of men with abdominal obesity had some degree of ED. Obesity causes inflammation throughout the body, and that inflammation can affect blood vessels in the penis.
- Obstructive sleep apnea (OSA): This condition causes the upper airways to collapse during sleep, impeding air (and consequently) blood flow, upping the risk of ED. It’s been estimated that 69% of men with OSA have ED.
What’s more, some of the drugs used to treat these medical conditions—including antihypertensives to treat high blood pressure and diuretics used for heart disease—can have ED or loss of libido as a side effect.
RELATED: Erectile dysfunction statistics
Is it normal to experience ED at a “younger” age?
While it’s not common for young, healthy men to have ED, it does happen. In fact, the prevalence of ED in men in their 20s is 8%, says Gabriel Neal, MD, a family medicine practitioner and clinical associate professor at Texas A&M University College of Medicine. Research shows that 11% of men 30-39 have ED.
Because it’s often associated with aging, ED in younger men has not been well studied. It’s apparent, though, that young men can have all the health conditions—diabetes, high blood pressure, albeit with less frequency—that predispose older men to problems with their erectile function. They may also have spinal cord or brain injuries that impair sexual performance and limit sexual activity.
However, experts note that ED in younger men is often linked to lifestyle habits and mental health issues that affect sexual health. These include:
- Smoking: A cigarette habit can cause hardening of the arteries involved with erection, including the coronary arteries. One study found that men who smoke marijuana are twice as likely to have ED than nonsmokers.
- Drinking alcohol in excess: A study of men with a mean age of 37 found that 33% of those who chronically used alcohol had ED.
- Depression or anxiety: Some research indicates that up to 20% of ED has psychological causes, which isn’t so surprising seeing how sexual performance relies on mental as well as physical cues and stimulation.
Even one bad experience can have a snowball effect, fostering performance anxiety and low self esteem. “If a guy has an initial failure [getting or maintaining an erection] it’s like building a house of cards,” notes Dr. Valvo. “One card comes out, and everything else tumbles down.”
How do I know if I have ED?
Erectile dysfunction can often be self-diagnosed by identifying symptoms. These include:
- Failure to get an erection at any time
- Failure to maintain an erection during sex
- Being able to get an erection sometimes, but not every time, you want to have sex
How is ED treated?
A SingleCare survey found that 39% of respondents with ED never sought treatment. It’s important to know that ED is treatable, and it typically begins with finding the root of the problem. However, before you seek out ED treatment, you’ll need an official diagnosis. Your healthcare provider will get a complete medical history from you and ask you some pointed questions about your sex life and your sexual performance—for example, how satisfying sexual intercourse is for you,how hard your erections are, and whether you experience ejaculation problems. They may also order things like blood tests (to check for diabetes or kidney disease or even low testosterone, which can impact sexual desire) and ultrasounds to see how blood flows through the penis. Family physicians, internists, urologists, and endocrinologists are all equipped to treat the problem.
Regardless of what’s found, your healthcare provider will probably first recommend making lifestyle changes that could improve your sexual performance. These things may include:
- Quitting smoking
- Losing weight
- Limiting alcoholic drinks
- Stopping drug use
- Seeking counseling or treatment for things like anxiety and depression. One caveat: ED can be a side effect of some antidepressants, so be sure to discuss with your prescribing physician your sexual performance concerns.
“Treatment of the underlying causes of ED is the real key,” says Dr. Neal. “If it is from a medication, then finding an alternative medication is the first step. If it is stress or performance- anxiety related, then managing that is the first step. Generally speaking, weight loss and increased physical activity have been shown to improve sexual function in men. In men who have obstructive sleep apnea, treatment with CPAP [a machine that delivers pressurized air into the airways via a tube and mask] has been shown to improve sexual function as well.”
Oral medications called phosphodiesterase 5 inhibitors (PDE5 inhibitors) that help relax smooth muscle and increase blood flow to the penis are often very effective. Some of these medications include:
Side effects of these drugs are the same in younger men as older ones and can include headaches, stomach upset, and redness of the face and chest. What you probably won’t have to be concerned about? Painful erections that last hours on end. “These are some of the most prolific drugs prescribed,” assures Dr. Valvo. “That side effect may be on the warning label, but I’ve never personally seen it happen.”
Other ED treatments
Other treatment options include medications injected into the penis to increase blood flow (one is alprostadil, which can also be used as a suppository in the urethra), penile implants, and vacuum devices that help the penis fill with blood. The male hormone testosterone is sometimes recommended, but generally it is only reserved for men with low testosterone levels and who report having a low sex drive.
The bottom line: ED is treatable—and reversible. There’s no reason you—or your partner—should settle for an unsatisfactory sex life. “If you’re experiencing ED 50% of the time, seek out treatment,” advises Dr. Valvo. “There’s help.”