Andrew McCullough, MD, associate professor of clinical urology and director, male sexual health program, New York University Langone Medical Center. Lecturer: Auxillium. Research grant: Pfizer. Data safety monitoring board: Pfizer. Consultant: Slate Pharmaceuticals. Clinical trials: Warner Chilcott, Vivus, Lilly, Bayer-GSK, ICOS, Timm, Schering Plough, Aeterna.
The production factory of your semen is on an industrial scale, constructed from multiple locations in your genitourinary system. First there are the stars of the show, your spermatozoa, which are naturally synthesised in the seminiferous tubules within your testicles. During the ejaculation process, these then pass through your ejaculatory ducts and blend with fluids from your prostate, seminal vesicles and bulbourethral glands. This melting pot forms your semen as it arrives via urethral meatus (the end of your penis) to the cold light of day – or night.

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Erectile dysfunction, often referred to as ED, is characterized by a persistent and recurring inability to achieve or maintain an erection sufficient for sexual intercourse. Psychological, physical and lifestyle issues can all cause ED, as can trauma to nerves and arteries. The incidence of erectile dysfunction increases with age, but young men can also experience it.
Most men may not openly talk about their erection problems, but erectile dysfunction — when a man cannot achieve or maintain an erection well enough or long enough to have satisfying sex — is very common. According to the National Institutes of Health, 5 percent of 40-year-olds and 15 to 25 percent of 65-years old have ED. But while ED is more likely to occur as a man gets older, it doesn’t come automatically with age.

Who do I talk to about erectile dysfunction?


The answers to these questions, as well as physiological tests like an ultrasound or neurological assessment, can help determine the root cause of ED. Depending on the cause, different treatment options are available. Treatments range from medication, to hormone replacement therapy, to vascular surgery, to sex therapy and/or couples counseling. It sounds like you have ruled out many physical factors, in which case it may be useful to consider psychological factors. Often, couples counseling and/or sex therapy (as a couple or individual) can identify factors related to ED, help with communication, and improve sex for both partners. For a sex therapist, check out the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) web site and click on the "Locate a Professional" link.

Both James and Michael fit the profile of millennial ED: healthy men with functional penises who experience occasional deflation for psychological reasons rather than mechanical issues (the latter of which typically plagues older men). Researchers and the medical community are aware of this specific problem facing younger men, says Landon Trost, MD, a urologist at the Mayo Clinic.
Relationship problems often complicate erectile dysfunction. Improving your relationship may be part of the solution. It may be a good idea to get counseling together from a sex therapist, marriage counselor, or a medical specialist. "I almost always see couples together to discuss erectile dysfunction. It often turns out that both partners have issues regarding the sexual relationship and once they are out in the open, couples can work together on a more satisfying sexual experience," says Feloney. 

It’s important not to take a bout of psychological ED personally. Still, when confronting a suddenly soft penis in the moment, “It’s not you” can be hard to believe. For instance, Erin, 22, tried—really tried—to make sex with Drew* happen. The first time his erection died right before they were about to have sex, she improvised and gave him “really long” oral instead. But the lack of a boner was confusing. “That had never happened to me with a sexual partner, so I was like, ‘Okay, he’s just not into me,’” Erin recalls.

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