Erectile dysfunction is usually considered to be a condition that affects middle-aged or elderly men. The magazine advertisements and television commercials for erectile dysfunction drugs usually feature men in their forties and fifties. However, somewhat surprisingly, erectile dysfunction can affect younger men too, even teenagers.
Very little data exists on the prevalence of erectile dysfunction in teenage boys, although we do know that the disorder is highly age-dependent. At age 70, the prevalence of moderate to severe erectile dysfunction is nearly 59%. At age 40, the rate decreases to approximately 22%. In men under the age of 40, the disease is much less common, but still affects approximately 5-10%. There is no data specifically for men under the age of 18. However, since the Centers for Disease Control and Prevention (CDC) reports that half of males of high school age have had sexual intercourse and a third are sexually active on a regular basis, the prevalence may be much higher than we think.
Causes of Erectile Dysfunction in Teenagers
Because the primary risk factors of erectile dysfunction – heart disease, hypertension, and advanced atherosclerosis – are age-related and are not typically present in young men, ED in teenagers is usually associated with a psychological cause. Psychological causes can include performance anxiety (that is, being nervous or fearing rejection from a partner), guilt (possibly from being taught at home that sex is “dirty”), and depression. Often when a teenager has one bad sexual experience, his fear and anxiety is heightened even further during future attempts.
But not all erectile dysfunction in teenagers is caused by psychological reasons. Recent research has shown that erectile dysfunction in teenage boys can often stem from a physical cause. In a study published in 2009 in BJU International, Dr. John P. Mulhall from Memorial Sloan Kettering Cancer Center in New York City studied 40 males aged 14-19 who sought help at a specialized ED treatment center. Surprisingly, 74% of the young men had a physical problem, and 60% were found to have significant blood vessel problems. The remainder of the young men were considered to have psychological causes.
The mean delay between onset of symptoms and evaluation at the treatment center was 22.6 months, so obviously these young men had experienced more than just an isolated incident. Many came to the treatment center with one or both parents. As a result of the study, Dr. Mulhall strongly encourages vascular testing in young men, since it is impossible to make a diagnosis by asking questions alone.
A study by Turkish researchers also found that erectile dysfunction can often stem from physical causes. This study, which was published in Urology in 2001, did not include young teenagers, but did include 90 men aged 18-39 who sought help for “honeymoon impotence” (that is, the inability to achieve an erection during the initial sexual experience). Almost 28% of the men were found to have penile blood vessel abnormalities.
Other causes of erectile dysfunction in teenagers can include endocrine problems, low testosterone levels, excessive bicycling (which can injure the genital region), pelvic trauma, spinal cord injury, use of antidepressants (especially SSRIs), and heavy alcohol use. Although diabetes, hypertension, and smoking can be risk factors for erectile dysfunction in older men, they are unlikely to be causes in teenagers, since these it takes many years or even decades for these conditions to cause vascular damage.
Treatment of Erectile Dysfunction in Teenagers
According to Dr. Mulhall and his colleagues, prompt treatment is necessary regardless of whether the cause is physical or psychological. Endocrine problems can often be treated effectively with hormone therapy. Blood vessel problems can be treated with vascular surgery. When a psychological cause is identified, treatment usually involves both medication and psychotherapy. Dr. Mulhall believes there is value to “nipping things early in the bud” so that young men do not develop a chronic lack of sexual confidence. He adds that young men with erectile dysfunction problems are more likely to develop depression and issues at school.
Are erectile dysfunction drugs such as Viagra, Cialis, and Levitra safe in teenagers? Unfortunately, very few drugs are tested on children and teenagers since it is not cost effective for pharmaceutical companies. In addition, many parents are unwilling to permit their children to participate in clinical trials for untested drugs. The labels for most erectile dysfunction drugs contain warnings about use in pediatric patients. However, many doctors prescribe these drugs to teenagers with good results. There have also been recent news reports about doctors giving infants and babies Viagra to save them from a life-threatening lung condition.
If a medication is advised for a teenager with erectile dysfunction, it should be prescribed at the lowest possible dose and the patient should be monitored closely for potential side effects. Teenagers should never mix ED medications with mind-altering drugs such as ecstasy or crystal methamphetamine. The use of this combination for recreational use is the rise and is potentially deadly.
If psychotherapy is advised, it is important to find a professional who specializes in working with teenagers. In general, psychotherapy assumes that erectile dysfunction is the sign of an underlying subconscious problem, and that discovering and resolving the problem will cure the erectile dysfunction. Part of this approach involves reassuring and encouraging the patient, and giving him an opportunity to say what is on his mind.
If you are a teenager suffering from erectile dysfunction, a complete physical examination by your doctor or healthcare provider is essential. Your doctor can determine if any other conditions are involved and help you choose the safest and most effective therapy. Surgery, hormone treatment, medication, and psychotherapy can all be effective treatments.
Source: Boston University School of Medicine
Source: Journal of Urology
Source: BJU International