Erectile dysfunction is often seen as a problem for older men, but new research suggests younger men are struggling too.
A recent study of thousands of American men under 40 found nearly 15 per cent struggled with erectile dysfunction. Most cases were strongly linked to psychological, rather than physical, causes.
Other studies have suggested psychological or emotional factors may explain as many as 85 per cent of ED cases.
Experts say erectile dysfunction at any age is rarely just a “failure of manliness.” But for younger men in particular, it is a condition often rooted in psychological and relational factors.
“Usually with erectile dysfunction, there’s a relational dynamic that is going on,” said Toronto sex therapist Eric Pierni.
“The environment is not conducive to creating what they’re looking for.”
Erectile dysfunction
Sex experts say it is normal to lose an erection occasionally.
“I don’t think there’s a man on the planet who hasn’t had that experience,” said Pierni, who is also the founder of Men Therapy Toronto, a clinic that provides male counselling services.
Dr. Ryan Flannigan, a reproductive microsurgeon at the University of British Columbia, says erectile dysfunction is diagnosed when someone cannot achieve or maintain an erection for at least six months.
ED falls into three categories: difficulty achieving a rigid erection, trouble maintaining one and situational ED, or erectile dysfunction that occurs inconsistently, such as with a partner or during first-time encounters.
“Sometimes situational could be only when they’re in partnered activity or with new partners, if they’re more nervous or anxious,” said Flannigan, who is also an adjunct assistant professor at Weill Cornell Medicine in New York.
“It’s another indication that there’s probably a psychological factor playing into this.”
Flannigan’s clinic, located on the Vancouver General Hospital campus, primarily treats patients for physiological causes of ED. The most common physiological cause is a venous leak, where a muscle in the erection chamber fails to trap blood, preventing a sustained erection.
Other physiological causes include arterial insufficiency, or reduced blood flow to the penis, nerve damage, or hormone imbalances, such as low testosterone. Certain medications — including some antidepressants, anti-anxiety drugs and blood pressure treatments — can interfere with the ability to achieve or maintain an erection.
‘Sexual robots’
Flannigan and others say erectile dysfunction is often a mix of physiology and psychology.
“The mind-body connection is so important,” Flannigan said.
Morag Yule, a psychologist and director of the clinic Ontario Sex Therapy, agrees.
“People often think about sexuality as being about the genitals, but … the biggest sexual organ is actually the brain,” said Yule.
A 2018 review of 49 international studies found that men with depression were 39 per cent more likely to experience erectile dysfunction than men without depression.
And yet, mental health is rarely assessed in ED clinical trials or included in treatment plans. A 2025 Canadian evaluation of more than 450 ED clinical trials found that fewer than eight per cent mentioned mental health issues.
Experts say that feeling relaxed and secure is key to arousal. Erections depend on the body’s “rest and digest” system; anxiety flips the switch to “fight or flight,” flooding the body with adrenaline and shutting things down below the belt.
“You’re probably not looking to have an erection when you’re running away from a saber tooth tiger,” said Flannigan. In intimate situations, anxiety — whether from a first-time partner or a previous negative experience — triggers hormones that can inhibit erections.
“That type of anxious, nervous, fearful response will produce … hormones [that] basically tell the muscle to contract rather than expand, so you get venous leak, and it can also tell the artery to contract rather than dilate, so less blood goes in,” he said.
Yule frames it psychologically.
“Am I going to get hard? Am I going to be good in bed? Does she like me? Does he like me?” she said. “We don’t want to be having sex and orgasms when we’re in fight or flight.”
Erectile dysfunction often appears in casual encounters, Pierni says, where men feel pressure to “perform” with partners they do not feel connected to.
“[In] hookup culture … sometimes I have to explain to them that it actually might be a sign of health that you’re not performing,” he said.
Some young men admit they do not like their partner but still feel pressure to prove themselves sexually. “Sometimes this is about validating their masculinity — making sure that they’re a ‘real man’.”
Man up
While studies suggest men in relationships may have lower odds of erectile dysfunction than single men, the quality of the relationship matters.
“Usually there’s some kind of emotional disconnect,” said Pierni, who often sees clients who are not opening up or being vulnerable with partners.
“There’s no safety for them to be able to experience the erection,” he said.
More troubling, he says, are men who arrive in therapy under pressure or threats from their partners.
“I am seeing more partners … upset about this performance issue and then mandating therapy, and the client is literally sitting scared … because the relationship is threatened,” he said.
To reframe the dynamic, Pierni uses role-reversal. “If you’re watching a movie, and the woman was struggling to perform in whatever way, and the man was … getting upset and telling her, ‘you’ve got to go fix that’ — how would that scenario feel for you?” he said.
Yule adds that women may react emotionally, interpreting erectile dysfunction as a lack of attraction. But that is not how arousal works, she says.
“[Arousal] is not a lightning bolt to the genitals [and then] all of a sudden there’s an erection if a guy sees a hot girl,” Yule said.
“That’s kind of how it’s presented — this idea of men as sexual robots [where you] should be able to get it up if … you’re a man.”
Pierni suspects social media makes it worse, with men compared to “masculine” online personas.
“We literally have men coming into the office saying that their partners have seen the way men are on social media and say, ‘Why aren’t you that way?’” said Pierni.
“[Partners are] telling our clients … that they’re here to learn how to ‘man up’.”
Identity crisis
Relational issues are compounded by rising stress and declining mental health among young Canadian men in general.
In a 2025 study by the Canadian Men’s Health Foundation, nearly two-thirds of young men reported moderate-to-high levels of stress.
Yule and Pierni say clients cite pressures from rising living costs, climate anxiety and political polarization. “It’s not sexy times,” said Yule.
Amidst these external pressures, a crisis of male identity is unfolding.
Pierni says he sees many clients fall into two extremes. Some equate masculinity with patriarchy, believing they must embody the old-school “Marlboro Man.” Others reject masculinity entirely, equating it with toxicity, and become chronic “people-pleasers.”
“They struggle with their intimate relationships because there’s no assertiveness there,” said Pierni. “An erection is a form of an assertion.”
Pierni says his clinic helps men find a middle ground — neither domineering nor self-erasing, but rooted in authenticity.
When asked to describe an “authentic male,” his clients often say “strength, power, courage.” Pierni counters with a different answer: love — the courage to be vulnerable and honest.
Yule notes many men never receive tools to think critically about masculinity. “People don’t talk to men about vulnerability and emotions, aside from what’s shown on TV or the darker corners of the internet,” she said.
“It’s really, really difficult to buy into the idea that masculinity can be more than what we’re told.”
“erectile dysfunction is diagnosed when someone cannot achieve or maintain an erection for at least six months”. Six months!! I thought at 52 minutes I was doing great. Who can maintain an erection for at least six months? 😄