Something James, 26, knows for sure about his penis is that it won’t get hard when he’s sleeping with a woman for the first time. No, it has nothing to do with how attracted he is to her. It’s just a classic case of performance anxiety, caused by his personal fears about how awkward and uncomfortable the experience could be—which, of course, turns into a self-fulfilling prophecy.

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"It definitely was a blow to my masculinity," Francis told Mic. "It didn't help that my wife at the time would say that I must be gay if I couldn't keep it up for her." Compounding the issue, if an erection doesn't happen during a given sexual encounter, the man can obsess over it, inevitably creating pressure and making it difficult for him to become fully aroused during future encounters. 
Erectile dysfunction is your body’s “check engine light” because ED can be an early sign of serious health problems like high blood pressure, diabetes, high cholesterol or low testosterone. The blood vessels in the penis are smaller than other parts of the body. So ED symptoms often occur long before more serious problems like a heart attack or stroke. When an otherwise healthy man in his 20’s experiences ED, it’s cause for concern.
Men with a healthy lifestyle and no chronic disease had the lowest risk for erectile dysfunction; the greatest difference was seen for men aged 65-79. For instance, men who exercised at least three hours per week had a 30% lower risk for ED than those who exercised little. Obesity, smoking, and excessive TV watching were also associated with having a greater risk of erectile dysfunction.
Ginseng (Panax ginseng) opens the arteries, including those that carry blood into the penis. Korean researchers gave 90 ED sufferers one of three treatments: a placebo, an antidepressant (trazodone), or ginseng. The placebo and antidepressant groups showed 30 percent erection improvement, the ginseng group, 60 percent. Other Korean scientists repeated this study, giving a placebo or ginseng (2,700 mg/day) to 45 men with ED. After 8 weeks, the ginseng group reported firmer erections. However, 2,700 mg of ginseng might cause jitters and possibly insomnia.
Depending on the age of the man, the reason why he is experiencing deficiencies in maintaining an erection will be due to a cause or another. Among young men, it is often due to psychological factors, either due to the size of the penis, past experiences, depression, undervaluation or other reasons, but can be summarized as: fear of sexually disappointing the couple.
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.

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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. 

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Where it comes from: When talking about erectile dysfunction, it's important to note that while there are many potential causes, they can essentially be divided into two discrete categories: physical and psychological. It's also important to note that there's a huge difference between chronic ED and the occasional (and very normal) inability to maintain an erection during sex.  
Stiffy Solution: Frustratingly enough, the only solution to exhaustion-based impotence is to get some rest, which is obviously difficult (or your dude wouldn't be having this problem in the first place). But if your guy has been resistant to getting help for his insomnia or asking for different hours at work, the inability to get his nine iron out on the putting green might be the thing that finally motivates him to make a life change. So, at least there's that.

Ask about transurethral pharmacotherapy. Your doctor may suggest you try this treatment, which involves placing a suppository into the urethra. The suppository contains alprostadil, which is then absorbed into the blood stream, relaxing blood vessels and improving blood flow into the penis. This treatment is thought to be less effective than the vacuum devices, or injection therapy.[16]
It can be difficult and frustrating for men and their partners to cope with erectile dysfunction, especially when the cause is unclear. At this point, it is important to be supportive and understanding of the situation and of one another. Erectile difficulties can cause feelings of inadequacy in both men and their partners. Each may internalize the situation, fearing that s/he is the one to blame. Therefore, open and honest communication with one another is an essential ingredient in strengthening your relationship as you work through this situation together.
It can be difficult and frustrating for men and their partners to cope with erectile dysfunction, especially when the cause is unclear. At this point, it is important to be supportive and understanding of the situation and of one another. Erectile difficulties can cause feelings of inadequacy in both men and their partners. Each may internalize the situation, fearing that s/he is the one to blame. Therefore, open and honest communication with one another is an essential ingredient in strengthening your relationship as you work through this situation together.

"One of the reasons erectile dysfunction increases with age is that the diseases that lead to it also increase with age," notes Dr. Feloney. Evaluating the causes of erectile dysfunction starts with your doctor taking a good health history and giving you a physical exam. Common medical issues that can lead to erectile dysfunction include diabetes, high blood pressure, hardening of the arteries, low testosterone, and neurological disease. Talk to your doctor about better managing these health conditions.

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There are a lot of explanations for these high ED rates, some of which are psychological. “A lot of men may have an off night, and then that sticks in their head and hurts their performance for a few weeks or months,” Dr. Köhler explains. He says anxiety stokes hormones like the fight-or-flight chemical adrenaline, which is a serious boner killer. (In evolutionary terms, it would be tough to run away from a predator with an erection.)
Avoid cholesterol and high blood pressure: high blood pressure and high cholesterol damage the blood vessels and that doesn’t exclude those blood vessels to the penis. This can lead to the issues of ED. Make sure your doctor keeps an eye on your blood pressure and cholesterol levels. One can also get a check of their blood pressure during the visits to their physician as part of a regular checkup.
If you're still experiencing issues with getting an erection after a few weeks, Dr. Axe says it's time to schedule an appointment with your doctor. "Ask about what health issues can be causing erectile dysfunction, such as cardiovascular problems, hormone imbalances or neurological disorders," he suggests. "It's also important to discuss your medications with your doctor, if you are taking any. Some medications can cause issues with blood flow, so your doctor may choose to change or lower those prescriptions."

As a relatively young man, Mher was in the minority of patients with erectile dysfunction, who are predominantly over the age of 50. But he's far from the only young man who's struggled with the condition. According to a 2013 study in the Journal of Sexual Medicine, an estimated one in four patients with new, onset ED are under the age of 40 — yet because we rarely hear about these men, they're left feeling embarrassed and alone.

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