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This is part one of a two-part series on .

Over my 35 years of practice, I’ve become used to seeing older men with erectile dysfunction (ED) problems, but recently I’ve been surprised to find a different clientele dealing with ED: millennials and teens. And the number is growing rapidly. They come in , , ashamed, and thinking that something is wrong with them because they believe that young men shouldn’t have ED.

Many of my colleagues are hearing similar stories. Some reports claim that up to a third of young men now experience ED. There are a growing number of websites and chat rooms dedicated to discussions about it, and it’s even creeping into mainstream media. Last year, Cosmopolitan surveyed 500 men and women between the ages of 18 and 38, and found that a whopping 80 percent of the responding men had at least once experienced trouble getting an erection during sex, and a high number of the responding women said they were grappling with the issue as well, trying to figure out if the problem was the man’s or theirs. It certainly is awkward and challenging for both partners.

So, what’s behind this phenomenon? There are a number of factors, and some sad misconceptions.

First, the misconceptions. Among the reactions to young men’s ED problems is a sort of pseudo-science and chat room ignorance that points the finger at and . The general idea they are propagating is that frequent masturbation to porn is so desensitizing and addictive that it’s ruining sex. Their solution: Completely stop watching porn and masturbating. Then, they say, you’ll gradually begin to be able to get an erection again and have real sex with a flesh-and-blood partner.

If this was true, then when someone stops watching porn and masturbating, the ability to have an erection would soon return naturally. But that’s not my clients’ experience. Some have come to me because, in fact, they have long since stopped watching porn and it didn’t fix the problem.

Then, we have religion-based ideas that masturbation is a sin, and that porn poisons the soul. Some legislators even seek to pass laws banning porn, as if that would help. When you make something illegal it only increases the desire for it. And there are too many examples of how abstinence, celibacy, and righteousness about moral purity have been the downfall of many a religious . Let’s face it: American history demonstrates that, for the most part, as a culture, we’ve never felt really comfortable with sex or sexual pleasure. Historically we’ve even tried to reduce sexual desire and lustful thoughts by eating the right food (read up on the origins of Kellogg’s cereals), insisting that women wear clothes that won’t tempt men, banning public nudity (even on statues), and so on.

Other Contributing Factors

Sex . In many American communities, we refuse to talk with our children about sex or sexual pleasure, or allow our schools to do so. Isn’t it ironic that the very act that creates children is so taboo that we can’t even talk to them about it? In Utah, for instance, discussing details of sexual intercourse and the use of contraceptives or sexual activity outside of is banned in schools.

It’s not this way in other parts of the world. In the Netherlands, for instance, such an education begins with 4-year-olds in kindergarten. The Dutch don’t call it “sex education,” but rather “ education” or “comprehensive sex ed,” consisting of open and honest conversations about love and relationships. The youngest students aren’t immediately taught about intercourse, but by the time they’re 11 years old, they’re far better equipped than American youth to make better choices about when and when not to engage in sex, and how to respect their own and others’ boundaries. The Dutch believe sexual development is a normal process that all young people experience and that they have the right to frank, trustworthy information on the subject. Consequently, they have less around sexuality and fewer teen pregnancies and fewer STIs than we do.

Here, abstinence-only sex education is the prevalent mode taught in schools, and numerous studies have shown that these programs neither succeed in reducing rates of teen pregnancies or STDs nor have they demonstrated efficacy in helping adolescents to delay intercourse.

Sexual imagery. Porn offers a false education. Kids as young as 11 or 12 can easily find porn, and without a deeper understanding of the dynamics and requirements of having an intimate relationship, they come to think that it’s all about limited foreplay, quick penetration, and . I can agree to some extent with those who say porn may contribute to these kids later having problems with ED, but not because it’s warping their minds or souls. Rather, masturbation doesn’t require any real sexual skills such as honest, erotic conversation between partners, learning how important foreplay is, or how penetration and orgasm are not the only . Rather, enjoying the full experience of between partners should be the goal. When a real sex partner comes along, it requires a wholly different set of mental skills than someone whose entire sexual education has come from watching porn.

Sex education focuses on sexual functioning. Porn focuses on sexual pleasure. We need something in between.

Movies and mainstream media. Movie sex happens quickly, with little if any foreplay or conversation, and sometimes even with violence. Too often, movies portray none of the realities and frequent awkwardness real people experience during sex. This leads to unrealistic expectations or to feeling bad about oneself. I recall a Showtime series about the lives of gay men years ago called Queer as Folk that had, for the first time in mainstream media, some very graphic sex scenes between men. I was in my thirties when I saw this show and felt immediate shame because the men acted with such ease and knowledge that I felt like something must be wrong with me. For me, sex was never so easy or instantly gratifying, but these actors seemed to be so confident with having sex and knew about tools and techniques that had never even occurred to me. So, the show wasn’t educational for me, just intimidating.

Good, pleasurable sex requires a degree of emotional skills, mental skills, and a recognition of your own vulnerability, not just tools and techniques.

Medications. Many young men today are on , drugs, and the like, and have been since their early teens. The National Center for Health Statistics reports that 5 percent of American 12-to-19-year-olds use antidepressants, and another 6 percent use for ADHD—in total, about 4 million , and the numbers keep growing. It’s widely known that these drugs interfere with one’s ability to get and keep an erection, as well as the ability to feel deeply the sensations and emotions that make for powerful sex. The continuing over-prescription of anti-depressants, etc., will, I believe, lead to more ED problems in the coming years.

. As a therapist, I’ve also seen many young men who have experienced some form of sexual abuse in their . Studies calculate that as many as one in six boys have been sexually abused. This can interfere with sexual pleasure and keeping an erection, and it can happen as if out of the blue when something that triggers memories shows up in bed. Then, is required in order to work through this before they are able to fully engage in sex.

Psychological problems. About 1 per 100 children have some degree of Obsessive Compulsion Disorder ( ), boys at about the same rate as girls. Having OCD likely means that you will focus laser-like on your lack of ability to get or maintain an erection, and this makes the ED problem even worse. The person must first work through the OCD therapeutically because ED is the symptom, not the root of the problem.

Pressure to procreate. When young couples are trying to make a baby, the joy and romance of sex can fly out the window. For the man, inseminating his wife becomes a job rather than an adventure, and ED often follows.

Shame and . If a man experiences ED several times ,or even once, and if his partner takes it personally (“You don’t find me attractive anymore,” etc.), he may begin to fear that the partner will leave him, and this only increases the that will surely lead to more ED problems.

Physical problems. Finally, there may be an actual physical problem lurking beneath someone’s ED. I advise anyone experiencing ED to see their doctor to rule this out. If ED meds are needed, there is no shame in this. When you break a leg, you don’t protest that “I don’t need these crutches. I will tough this out and it will heal on its own.” You wouldn’t do that for a broken leg, so don’t do it for your erectile difficulties. You may only need to use ED drugs like Viagra for a short time until you learn how to maintain your erotic focus.

There are ways to help overcome the problem, which I’ll address in part two of this post. That being said, the growing phenomenon of ED problems in younger men may only improve when we address the false mythologies surrounding both male and female sexuality, and aggressively embark on sexuality education for future generations.

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