Erectile Dysfunction in Younger Men: Why It Happens and What Can Actually Help

Erectile dysfunction is often thought of as a problem affecting older men, but we increasingly see younger men who are experiencing difficulties getting or maintaining an erection.

For some, the problem appears suddenly. Others notice a gradual change in erection quality, fewer morning erections or difficulty maintaining an erection during sexual activity.

Understandably, this can cause considerable worry.

At London Men’s Health Physiotherapy, we see younger men with erectile difficulties alongside conditions such as male pelvic pain, pelvic floor overactivity and Hard Flaccid Syndrome.

One of the most important things to understand is that not all erectile dysfunction is the same.

What is erectile dysfunction?

Erectile dysfunction, or ED, describes persistent difficulty getting or maintaining an erection sufficient for satisfactory sexual activity.

Symptoms can include:

• Difficulty achieving a full erection
• Losing an erection during sexual activity
• Erections feeling less firm than previously
• Reduced or absent morning erections
• Erections being better alone than with a partner, or vice versa
• Changes in penile sensation
• Pelvic or penile discomfort associated with sexual activity

There are many possible reasons for these symptoms, which is why an individual assessment is important.

Why can erectile dysfunction happen in younger men?

An erection requires several systems to work together.

Healthy blood flow, nerves, hormones, pelvic floor muscles and sexual arousal all contribute to normal erectile function.

Problems in any of these areas can potentially affect erections.

In younger men, erectile difficulties may involve a combination of physical and psychological factors rather than one single cause.

Can the pelvic floor affect erections?

Yes.

The male pelvic floor muscles have an important role in sexual function and contribute to erection and ejaculation.

However, pelvic floor problems are not always caused by weakness.

Some men experiencing erectile difficulties have an overactive or excessively tense pelvic floor.

This may be particularly relevant when ED occurs alongside symptoms such as:

• Pelvic pain
• Perineal discomfort
• Penile pain or altered sensation
• Pain after ejaculation
• Urinary urgency
• Difficulty relaxing the pelvic floor
• Hard Flaccid symptoms

In these situations, simply performing large numbers of pelvic floor strengthening exercises may not be appropriate.

Sometimes the initial priority is actually improving pelvic floor relaxation and coordination.

What about Hard Flaccid Syndrome?

Some younger men with erectile difficulties also describe symptoms associated with Hard Flaccid Syndrome.

The penis may feel unusually firm or contracted while flaccid, sometimes accompanied by altered sensation, pelvic floor tension, changes in erections and pelvic discomfort.

Hard Flaccid is a complex and still poorly understood condition.

Assessment therefore needs to consider the wider pelvis, pelvic floor and nervous system rather than focusing exclusively on the penis.

Stress, anxiety and erections

Sexual function is particularly sensitive to stress.

After experiencing erectile difficulty once or twice, it is very common to begin monitoring erections closely.

Thoughts such as:

“Will I get an erection?”

“Is it as hard as it used to be?”

“Am I going to lose it?”

can make sexual activity increasingly stressful.

This can create a cycle where worry about erectile function makes erections more difficult, which then creates even more worry the next time.

This does not mean that erectile dysfunction is simply psychological.

Physical and psychological factors frequently interact, and both should be taken seriously.

What about blood flow?

Good vascular health is fundamental to erectile function.

For this reason, persistent erectile dysfunction should not simply be assumed to be caused by the pelvic floor.

Depending on your age, symptoms and medical history, appropriate medical assessment may be recommended to investigate vascular, hormonal, neurological or other potential contributors.

This is particularly important when erectile dysfunction is new, unexplained or persistent.

How can Men’s Health Physiotherapy help?

A specialist Men’s Health Physiotherapy assessment looks at the wider picture.

Depending on your symptoms, we may assess:

• Pelvic floor function
• Ability to contract and relax the pelvic floor
• Pelvic and hip movement
• Abdominal and pelvic muscle tension
• Breathing patterns
• Pudendal nerve symptoms
• Penile or perineal sensitivity
• Bladder and bowel symptoms
• Exercise and gym activity
• Sexual symptoms and symptom triggers

The aim is to identify factors that may be contributing to the problem rather than assuming every man needs the same treatment.

What might treatment involve?

Treatment depends entirely on what is found during assessment.

It may include pelvic floor rehabilitation, relaxation techniques, breathing exercises, manual therapy, advice around exercise and activity, management of associated pelvic pain and a gradual return to normal sexual activity.

Where appropriate, we also work alongside urologists and other medical specialists.

The important point is that treatment should be individualised.

A younger man with an overactive pelvic floor, pelvic pain and erectile difficulties may require a very different approach from somebody whose erectile dysfunction is predominantly vascular.

Should younger men be embarrassed about ED?

Absolutely not.

Erectile difficulties are far more common than many men realise.

Because sexual problems are rarely discussed openly, younger men can feel particularly isolated and may spend considerable amounts of time searching online for an explanation.

Unfortunately, this can sometimes increase anxiety rather than provide useful answers.

Having the opportunity to discuss the problem openly with a clinician who regularly works with male sexual and pelvic health problems can be extremely helpful.

Specialist Erectile Dysfunction Physiotherapy in London

At London Men’s Health Physiotherapy, we regularly see men with erectile dysfunction, Hard Flaccid Syndrome, pelvic pain, pudendal nerve symptoms and other male pelvic health problems.

We understand that erectile dysfunction is not one single condition and that younger men in particular may have very different contributing factors.

Our aim is to provide a discreet, thorough assessment, explain what may be contributing to your symptoms and develop an individual treatment and rehabilitation plan.

If you are experiencing erectile difficulties and would like to discuss whether specialist Men’s Health Physiotherapy may be appropriate, please contact London Men’s Health Physiotherapy.