Erectile dysfunction is on the rise among young people. Some studies estimate that up to 35 percent of men under 40 say they can’t get it up or keep it up for satisfying sex, and urologists report seeing more and more young patients concerned about erectile dysfunction.
If you’re experiencing erectile dysfunction (ED), the first priority is to release any shame you may feel around your sexual prowess. Stigmatizing social narratives around your ability to perform in bed and what it may mean for masculinity will only make things worse. So will the word “impotent,” a lay term for erectile dysfunction that, I’d say, is pretty judgy.
Erectile dysfunction is a common medical condition, and I’m here to help.
What is an erection?
To understand erectile dysfunction, one must first understand erections.
Dr. Rainey Horwitz is a sexual medicine researcher, sex educator, and urology resident based in Atlanta. I asked her for the low-down on hard-ons.
“An erection is basically what we call the tumescence,” Horwitz said, “which is the filling of blood within these spongy tissues in our erectile structures.”
The erection is quite a sophisticated biological phenomenon, Horwitz told me. For a penis to get hard, the cardiovascular, hormonal, and neurological systems must all come together in harmony.
The corpora cavernosa—spongy tube-like structures in the penis—are connected to neurotransmitters that respond to hormones like testosterone and oxytocin; they become rigid by filling with blood. These hormones, along with nitric oxide, a chemical produced by the brain, all contribute to the maintenance of pathways and triggers responsible for an erection.
So basically, what seems like a relatively simple event (sexually exciting stimulus gives me a boner) actually involves a complex series of biological functions.
On the one hand, that should be of comfort to anyone who’s experienced ED: There’s a lot that has to go right for your rod to rise! On the other hand, it also means that when it comes to erectile dysfunction, there could be many potential root problems.
Who gets erectile dysfunction?
While more young people are reporting experiencing ED, its prevalence definitely rises with age. Among men 65 and older, roughly half reported ED, according to data from the 2021 National Survey of Sexual Wellbeing that was analyzed for a 2024 paper published in the Journal of Sexual Medicine.
Most of these studies focus on cis men. But it’s also common for trans women to lose their ability to get hard as they transition. Undertaking hormone-replacement therapy deliberately sends testosterone plummeting.
While the volume of formal academic research on trans health is disappointingly thin, I found one study showing that of the 307 trans women surveyed, more than two-thirds reported at least one sexual dysfunction.
Erectile dysfunction was not listed among the options, but about a quarter of respondents reported either difficulty in achieving an orgasm or difficulty initiating and seeking sexual contact. It’s hard to imagine that flaccidity or a general nervousness around sexual performance isn’t at play in some of these situations.
Academic journals may be ignoring this problem of transfemme ED, but the internet is not.
One Reddit thread on the subject includes more than 60 comments describing the variety of changes to trans women experience with their erections while undergoing medical transition. In my circles, I’ve seen several memes joking about transfemme erectile dysfunction on Instagram. One shows an image of a doll nervously biting her nail with the caption, “When he wants you to be his TS [transsexual] fantasy but you have IBS and your dick stopped working years ago.”
What causes erectile dysfunction?
Since an erection involves three major parts of our body—the blood, the hormones, and the brain—a kink in any one of those can make it hard to rise to the occasion.
Hormonal issues may be the most familiar culprit. Horwitz told me that as men age, they can experience hypogonadism or lose the amount of testosterone that’s made by their testicles. Testosterone manages not only libido, but plays a role in the biochemical pathways partially responsible for triggering erections.
ED gets more common among older people because testosterone production declines as we age. The same goes for trans women who undertake feminizing hormone replacement therapy: Taking anti-androgens and estrogen medications lowers their natural testosterone levels.
Cardiovascular functioning can be another root cause of ED.
Because you need good blood flow to pitch a trouser tent, the same health conditions that affect heart health can also affect erections, Horwitz said. Diabetes and high cholesterol both impact the cardiovascular system, making it harder for blood to pump through the body and making blood vessels—including those in your penis—more prone to clogging up.
We talked about the heart and the hormones. Now comes the head.
Because the human body is a beautiful symphony of disparate systems working in harmony, poor mental health can also make it harder to, well, get hard.
“Your brain is the strongest sexual organ,” Horwitz said.
Serotonin and dopamine are a complicated biochemical combo that interplay with each other. Each has a role in your libido—and are also implicated in many mental health conditions. If poor mental health makes your baseline sexual appetite low, it can be harder to achieve the excitement required for an erection. A survey of 511 patients diagnosed with ED found that 65 percent also had depression.
Certain medications can also cause your flag to fly at half mast. For instance, Horwitz said, GLP-1s like Ozempic can kill some people’s cravings not just for food, but also for other pleasures in life, from smoking and alcohol, to sex. Beta blockers, blood pressure medications, and certain mood stabilizers have also been linked to erectile dysfunction.
How do I treat erectile dysfunction?
The causes for erectile dysfunction are myriad—and so are the solutions.
It’s important to talk to your doctor if you’re having trouble having and maintaining erections. They can help assess whether the issue is related to your diet, hormones, mental health, cardiovascular system, or some combination. Depending on the diagnosis, there are many possible treatments, from switching meds to surgically implanted devices that help inflate the penis to get it ready for action. (Horwitz called these implants the “Cadillac” of ED treatments.)
One well-known ED medication is Viagra, which is now available as the generic drug sildenafil. This medication, originally trialed to treat heart problems, works by relaxing the blood vessels, which can help increase blood flow to the penis during sexual stimulation.
If you know me, you know what I’m going to suggest next: Sex toys are a great option to try if your captain won’t salute.
Horwitz agrees. Cock rings, which are worn around the base of the penis and testicles, do wonders to keep people hard. They work because veins are soft and squishy, while arteries are rigid and elastic. So the rings apply pressure to the vessels that carry blood out of the penis while vessels that bring blood in stay open, maintaining tumescence. Cock rings can also increase sensitivity for a more intense overall experience.
Horwitz suggested a cock ring from FirmTech made of elastomer that was designed by an emergency medicine physician—so safe you could sleep in it. Once, she told me, she had to spend five hours sawing a guy out of a titanium cock ring using a diamond drill-bit. (You definitely don’t want to be like that poor fellow!)
Other body parts are hard, too
Erections, orgasms, and ejaculation are all different functions. So if you really can’t get hard, it’s still possible to achieve sexual satisfaction.
If you have a penis, you likely have a prostate, which is a sexual pleasure organ, too! Vibrating U-shaped butt plugs that stimulate the prostate and the perineum can be highly enjoyable and even help you achieve an orgasm without ever having an erection.
If you’re someone with a penis that would like to satisfy someone else, may I remind you that you also have a mouth, hands, and feet? Those are all very rigid, and very useful body parts.
And don’t forget about dildos. As long as you’re boiling your toys in between uses, feel free to insert that silicone phallus in a butt to your heart’s content—and theirs.
Partners play a pivotal role in managing someone’s ED. How they react to flaccidity can be either helpful or harmful. Shame and confusion can make everything worse.
Studies show that many female partners of men with ED report feeling inadequate or confused due to a change in their partner’s sexual behavior. But erectile dysfunction is not necessarily reflective of the quality or dynamic of your relationship—an understanding partner can help achieve a healthier sex life by accompanying their partner to the clinic and expressing acceptance and support. Redefining sex with your partner to include more oral, more hand stuff, and even mutual masturbation can keep things spicy!
Another study on ED in gay male couples looked at three key themes in navigating this issue: acknowledging the change, accommodating the change, and accepting the change. Positive responses included emphasizing verbal and non-verbal intimacy, using erectile aids like Viagra, and exploring opening up the relationship to alleviate the pressure of sexual satisfaction.
In all the couples surveyed, people noted that a communication breakdown contributed to stalemates or making things feel worse. These studies demonstrate that navigating sexual dysfunction can be hard but doable with understanding, creativity, and optimism.
Erectile dysfunction is generally treatable, Horwitz said.
Medically speaking, she added, between science and sex shops we can keep people “18-year-old hard until they die.”
So, if you’ve gone soft, talk it out, ask for help, and play around. With or without an erection, having fun in the bedroom doesn’t have to be hard.
The post Erectile Dysfunction Is Common Among Men and Trans Women. Here’s How to Navigate It. appeared first on Rewire News Group.
