Organic and Psychogenic Causes of Sexual Dysfunction in Young Men

Document Type: Narrative Review

Authors

School of Medicine, Tulane University, New Orleans, USA

Abstract

Sexual dysfunction, specifically erectile dysfunction (ED), premature ejaculation (PE), and delayed ejaculation (DE), are debilitating diseases, especially in young men. The past decade has seen an increase in the number of young men (under 40 years of age) presenting to their physician with sexual dysfunction. Traditionally, sexual dysfunction in young men was viewed as a strictly psychosomatic problem stemming from underlying psychogenic causes such as anxiety or insecurity. While this is true in some cases, the advent of new diagnostic tools and pharmacotherapy have revealed that the prevalence of organic causes for these diseases is much higher than previously thought. In reality, many patients present with primarily organic sexual dysfunction that then triggers concomitant psychogenic stressors such as anxiety and depression which exacerbate their problem. This review focuses on the common etiologies of sexual dysfunction experienced by young men in order to help educate clinicians so that they may better understand, identify, and serve this growing patient population.

Keywords


  1. Althof SE, Needle RB. Psychological factors associated with male sexual dysfunction: screening and treatment for the urologist. Urol Clin North Am. 2011;38(2):141-6. doi: 10.1016/j.ucl.2011.02.003. pmid: 21621080.
  2. Reed-Maldonado AB, Lue TF. A syndrome of erectile dysfunction in young men? Transl Androl Urol. 2016;5(2):228-34. doi: 10.21037/tau.2016.03.02. pmid: 27141452.
  3. McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, et al. Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135-43. doi: 10.1016/j.jsxm.2015.12.019. pmid: 26953828.
  4. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. pmid: 8254833.
  5. O'Sullivan LF, Brotto LA, Byers ES, Majerovich JA, Wuest JA. Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents. J Sex Med. 2014;11(3):630-41. doi: 10.1111/jsm.12419. pmid: 24418498.
  6. Martins FG, Abdo CHN. Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years. J Sex Med. 2010;7(6):2166-73. doi: 10.1111/j.1743-6109.2009.015 42.x. pmid: 19889149.
  7. Wilcox SL, Redmond S, Hassan AM. Sexual functioning in military personnel: preliminary estimates and predictors. J Sex Med. 2014;11(10):2537-45. doi: 10.1111/jsm.12643. pmid: 25042933.
  8. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537-44. doi: 10.1001/jama.281.6.537. pmid: 10022110.
  9. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Translational Andrology and Urology. 2017;6(1):79-90. doi: 10.21037/tau.2016.09.06. pmid: PMC5313296.
  10. Caskurlu T, Tasci AI, Resim S, Sahinkanat T, Ergenekon E. The etiology of erectile dysfunction and contributing factors in different age groups in Turkey. Int J Urol. 2004;11(7):525-9. doi: 10.1111/j.1442-2042.2004.00837.x. pmid: 15242362.
  11. Donatucci CF, Lue TF. Erectile dysfunction in men under 40: etiology and treatment choice. Int J Impot Res. 1993;5(2):97-103. pmid: 8348217.
  12. Ralph D, McNicholas T. UK management guidelines for erectile dysfunction. BMJ. 2000;321(7259):499-503. pmid: 10948037.
  13. Papagiannopoulos D, Khare N, Nehra A. Evaluation of young men with organic erectile dysfunction. Asian Journal of Andrology. 2015;17(1):11-6. doi: 10.4103/1008-682X.139253. pmid: PMC4291852.
  14. Fedele D, Bortolotti A, Coscelli C, Santeusanio F, Chatenoud L, Colli E, et al. Erectile dysfunction in type 1 and type 2 diabetics in Italy. On behalf of Gruppo Italiano Studio Deficit Erettile nei Diabetici. Int J Epidemiol. 2000;29(3):524-31. pmid: 10869326.
  15. Radicioni AF, Ferlin A, Balercia G, Pasquali D, Vignozzi L, Maggi M, et al. Consensus statement on diagnosis and clinical management of Klinefelter syndrome. J Endocrinol Invest. 2010;33(11):839-50. doi: 10.1007/BF03350351. pmid: 21293172.
  16. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev. 2017;5(4):508-20. doi: 10.1016/j.sxmr.2017.05.004. pmid: 28642047.
  17. Pan L, Xia X, Feng Y, Jiang C, Cui Y, Huang Y. Exposure of juvenile rats to the phytoestrogen daidzein impairs erectile function in a dose-related manner in adulthood. J Androl. 2008;29(1):55-62. doi: 10.2164/jandrol.107.003392. pmid: 17673432.
  18. Siepmann T, Roofeh J, Kiefer FW, Edelson DG. Hypogonadism and erectile dysfunction associated with soy product consumption. Nutrition. 2011;27(7-8):859-62. doi: 10.1016/j.nut.2010.10.018. pmid: 21353476.
  19. Sommer F, Goldstein I, Korda JB. Bicycle riding and erectile dysfunction: a review. J Sex Med. 2010;7(7):2346-58. doi: 10.1111/j.1743-6109.2009.01664.x. pmid: 20102446.
  20. Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta Neurol Scand. 1997;95(4):233-40. pmid: 9150814.
  21. Michiels M, Van der Aa F. Bicycle riding and the bedroom: can riding a bicycle cause erectile dysfunction? Urology. 2015;85(4):725-30. doi: 10.1016/j.urology.2014.12.034. pmid: 25681833.
  22. Yao F, Huang Y, Zhang Y, Dong Y, Ma H, Deng C, et al. Subclinical endothelial dysfunction and low-grade inflammation play roles in the development of erectile dysfunction in young men with low risk of coronary heart disease. Int J Androl. 2012;35(5):653-9. doi: 10.1111/j.1365 -2605.2012.01273.x. pmid: 22519624.
  23. Balercia G, Boscaro M, Lombardo F, Carosa E, Lenzi A, Jannini EA. Sexual symptoms in endocrine diseases: psychosomatic perspectives. Psychother Psychosom. 2007;76(3):134-40. doi: 10.1159/000099840. pmid: 17426412.
  24. Ludwig W, Phillips M. Organic causes of erectile dysfunction in men under 40. Urol Int. 2014;92(1):1-6. doi: 10.1159/000354931. pmid: 24281298.
  25. Krassas GE, Tziomalos K, Papadopoulou F, Pontikides N, Perros P. Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat? J Clin Endocrinol Metab. 2008;93(5):1815-9. doi: 10.1210/jc.2 007-2259. pmid: 18270255.
  26. Keller JJ, Liang YC, Lin HC. Association between multiple sclerosis and erectile dysfunction: a nationwide case-control study. J Sex Med. 2012;9(7):1753-9. doi: 10.1111/j.1743-6109.2012.02746.x. pmid: 22548978.
  27. Keller J, Chen YK, Lin HC. Association between epilepsy and erectile dysfunction: evidence from a population-based study. J Sex Med. 2012;9(9):2248-55. doi: 10.1111/j.1743-6109.2012.02670.x. pmid: 22429815.
  28. Mallet R, Tricoire JL, Rischmann P, Sarramon JP, Puget J, Malavaud B. High prevalence of erectile dysfunction in young male patients after intramedullary femoral nailing. Urology. 2005;65(3):559-63. doi: 10.1016/j.urology.2004. 10.002. pmid: 15780376.
  29. Siddiqui MA, Peng B, Shanmugam N, Yeo W, Fook-Chong S, Li Tat JC, et al. Erectile dysfunction in young surgically treated patients with lumbar spine disease: a prospective follow-up study. Spine (Phila Pa 1976). 2012;37(9):797-801. doi: 10.1097/BRS.0b013e318232601c. pmid: 21912318.
  30. Corona G, Ricca V, Bandini E, Mannucci E, Petrone L, Fisher AD, et al. Association between psychiatric symptoms and erectile dysfunction. J Sex Med. 2008;5(2):458-68. doi: 10.1111/j.1743-6109.2007.00663.x. pmid: 18004996.
  31. Bandini E, Fisher AD, Corona G, Ricca V, Monami M, Boddi V, et al. Severe depressive symptoms and cardiovascular risk in subjects with erectile dysfunction. J Sex Med. 2010;7(10):3477-86. doi: 10.1111/j.1743-6109.2010.019 36.x. pmid: 20633210.
  32. Smith JF, Breyer BN, Eisenberg ML, Sharlip ID, Shindel AW. Sexual function and depressive symptoms among male North American medical students. J Sex Med. 2010;7(12):3909-17. doi: 10.1111/j.1743-6109.2010.0203 3.x. pmid: 21059174.
  33. Mialon A, Berchtold A, Michaud PA, Gmel G, Suris JC. Sexual dysfunctions among young men: prevalence and associated factors. J Adolesc Health. 2012;51(1):25-31. doi: 10.1016/j.jadohealth.2012.01.008. pmid: 22727073.
  34. Jern P, Gunst A, Sandnabba K, Santtila P. Are early and current erectile problems associated with anxiety and depression in young men? A retrospective self-report study. J Sex Marital Ther. 2012;38(4):349-64. doi: 10.1080/0092623X.2012.665818. pmid: 22712819.
  35. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. doi: 10.1038/nrdp.2016.3. pmid: 27188339.
  36. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev. 2018;6(1):29-34. doi: 10.1016/j.sxmr.2017.07.002. pmid: 28778697.
  37. Khanzada U, Khan SA, Hussain M, Adel H, Masood K, Adil SO, et al. Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan. World J Mens Health. 2017;35(1):22-7. doi: 10.5534/wjmh.2017.35.1.22. pmid: 28459144.
  38. Gleason JM, Slezak JM, Jung H, Reynolds K, Van den Eeden SK, Haque R, et al. Regular nonsteroidal anti-inflammatory drug use and erectile dysfunction. J Urol. 2011;185(4):1388-93. doi: 10.1016/j.juro.2010.11.092. pmid: 21334642.
  39. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998;39(4 Pt 1):578-89. doi: https://doi.org/10.1016/S0190-9622(98)70007-6. pmid: 9777765.
  40. Civardi C, Collini A, Gontero P, Monaco F. Vasogenic erectile dysfunction Topiramate-induced. Clin Neurol Neurosurg. 2012;114(1):70-1. doi: 10.1016/j.clineuro.2011 .07.018. pmid: 21868149.
  41. Mykoniatis I, Grammatikopoulou MG, Bouras E, Karampasi E, Tsionga A, Kogias A, et al. Sexual Dysfunction Among Young Men: Overview of Dietary Components Associated With Erectile Dysfunction. J Sex Med. 2018;15(2):176-82. doi: 10.1016/j.jsxm.2017.12.008. pmid: 29325831.
  42. Austoni E, Mirone V, Parazzini F, Fasolo CB, Turchi P, Pescatori ES, et al. Smoking as a risk factor for erectile dysfunction: data from the Andrology Prevention Weeks 2001-2002 a study of the Italian Society of Andrology (s.I.a.). Eur Urol. 2005;48(5):810-7; discussion 7-8. doi: 10.1016/j.eururo.2005.03.005. pmid: 16202509.
  43. He J, Reynolds K, Chen J, Chen CS, Wu X, Duan X, et al. Cigarette smoking and erectile dysfunction among Chinese men without clinical vascular disease. Am J Epidemiol. 2007;166(7):803-9. doi: 10.1093/aje/kwm154. pmid: 17623 743.
  44. Mirone V, Imbimbo C, Bortolotti A, Di Cintio E, Colli E, Landoni M, et al. Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiological study. Eur Urol. 2002;41(3):294-7. pmid: 12180231.
  45. Millett C, Wen LM, Rissel C, Smith A, Richters J, Grulich A, et al. Smoking and erectile dysfunction: findings from a representative sample of Australian men. Tob Control. 2006;15(2):136-9. doi: 10.1136/tc.2005.015545. pmid: 16565463.
  46. Gades NM, Nehra A, Jacobson DJ, McGree ME, Girman CJ, Rhodes T, et al. Association between smoking and erectile dysfunction: a population-based study. Am J Epidemiol. 2005;161(4):346-51. doi: 10.1093/aje/kwi052. pmid: 15692 078.
  47. Yang Y, Liu R, Jiang H, Hong K, Zhao L, Tang W, et al. Association Between Dosage Frequency and the Treatment Outcomes of Sildenafil in Young and Middle-aged Men With Erectile Dysfunction: A Chinese, Multicenter, Observational Study. Urology. 2015;86(1):62-7. doi: 10.1016/j.urology .2015.03.011. pmid: 26142584.
  48. Kennedy SH, Dugre H, Defoy I. A multicenter, double-blind, placebo-controlled study of sildenafil citrate in Canadian men with erectile dysfunction and untreated symptoms of depression, in the absence of major depressive disorder. Int Clin Psychopharmacol. 2011;26(3):151-8. doi: 10.1097/YIC.0b013e32834309fc. pmid: 21471773.
  49. Simonelli C, Tripodi F, Cosmi V, Rossi R, Fabrizi A, Silvaggi C, et al. What do men and women ask a helpline on sexual concerns? Results of an Italian telephone counselling service. Int J Clin Pract. 2010;64(3):360-70. doi: 10.1111/j.1742-1241.2009.02269.x. pmid: 20456175.
  50. Lee SW, Lee JH, Sung HH, Park HJ, Park JK, Choi SK, et al. The prevalence of premature ejaculation and its clinical characteristics in Korean men according to different definitions. Int J Impot Res. 2013;25(1):12-7. doi: 10.1038/ijir.2012.27. pmid: 22931761.
  51. Hwang I, Yang DO, Park K. Self-Reported Prevalence of and Attitudes toward Premature Ejaculation in a Community-Based Study of Married Couples. World J Mens Health. 2013;31(1):70-5. doi: 10.5534/wjmh.2013.31.1.70. pmid: 23658869.
  52. Shaeer O. The global online sexuality survey (GOSS): The United States of America in 2011 Chapter III--Premature ejaculation among English-speaking male Internet users. J Sex Med. 2013;10(7):1882-8. doi: 10.1111/jsm.12187. pmid: 23668379.
  53. Waldinger MD. Premature ejaculation: state of the art. Urol Clin North Am. 2007;34(4):591-9, vii-viii. doi: 10.1016/j.ucl.2007.08.011. pmid: 17983899.
  54. Bartoletti R, Cai T, Mondaini N, Dinelli N, Pinzi N, Pavone C, et al. Prevalence, incidence estimation, risk factors and characterization of chronic prostatitis/chronic pelvic pain syndrome in urological hospital outpatients in Italy: results of a multicenter case-control observational study. J Urol. 2007;178(6):2411-5; discussion 5. doi: 10.1016/j.juro.2007. 08.046. pmid: 17937946.
  55. Screponi E, Carosa E, Di Stasi SM, Pepe M, Carruba G, Jannini EA. Prevalence of chronic prostatitis in men with premature ejaculation. Urology. 2001;58(2):198-202. doi: https://doi.org/10.1016/S0090-4295(01)01151-7. pmid: 11489699.
  56. Ahlenius S, Larsson K, Svensson L, Hjorth S, Carlsson A, Lindberg P, et al. Effects of a new type of 5-HT receptor agonist on male rat sexual behavior. Pharmacol Biochem Behav. 1981;15(5):785-92. doi: https://doi.org/10.1016/009 1-3057(81)90023-X. pmid: 6458826.
  57. Waldinger MD. The neurobiological approach to premature ejaculation. J Urol. 2002;168(6):2359-67. doi: 10.1097/01.ju.0000035599.35887.8f. pmid: 12441918.
  58. Jern P, Santtila P, Witting K, Alanko K, Harlaar N, Johansson A, et al. Premature and delayed ejaculation: genetic and environmental effects in a population-based sample of Finnish twins. J Sex Med. 2007;4(6):1739-49. doi: 10.1111/j.1743-6109.2007.00599.x. pmid: 17888070.
  59. Corona G, Jannini EA, Mannucci E, Fisher AD, Lotti F, Petrone L, et al. Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med. 2008;5(8):1991-8. doi: 10.1111/j.1743-6109.2008.00803.x. pmid: 18399946.
  60. Podlasek CA, Mulhall J, Davies K, Wingard CJ, Hannan JL, Bivalacqua TJ, et al. Translational Perspective on the Role of Testosterone in Sexual Function and Dysfunction. The journal of sexual medicine. 2016;13(8):1183-98. doi: 10.1016/j.jsxm.2016.06.004. pmid: PMC5333763.
  61. Sansone A, Romanelli F, Jannini EA, Lenzi A. Hormonal correlations of premature ejaculation. Endocrine. 2015;49(2):333-8. doi: 10.1007/s12020-014-0520-7. pmid: 25552341.
  62. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, et al. Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction. J Sex Med. 2009;6(5):1457-66. doi: 10.1111/j.1743-6109.2008.01206.x. pmid: 192107 05.
  63. Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, et al. Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab. 2005;90(12):6472-9. doi: 10.1210/jc.2005-1135. pmid: 16204360.
  64. McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJG. The pathophysiology of acquired premature ejaculation. Translational Andrology and Urology. 2016;5(4):434-49. doi: 10.21037/tau.2016.07.06. pmid: PMC5001985.
  65. Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey. Journal of Epidemiology and Community Health. 1999;53(3):144-8. pmid: PMC1756846.
  66. Hartmann U, Schedlowski M, Kruger TH. Cognitive and partner-related factors in rapid ejaculation: differences between dysfunctional and functional men. World J Urol. 2005;23(2):93-101. doi: 10.1007/s00345-004-0490-0. pmid: 15947962.
  67. el-Sakka AI. Severity of erectile dysfunction at presentation: effect of premature ejaculation and low desire. Urology. 2008;71(1):94-8. doi: 10.1016/j.urology.2007.09.006. pmid: 18242373.
  68. Ciocca G, Limoncin E, Mollaioli D, Gravina GL, Di Sante S, Carosa E, et al. Integrating psychotherapy and pharmacotherapy in the treatment of premature ejaculation. Arab Journal of Urology. 2013;11(3):305-12. doi: 10.1016/j.aju.2013.04.011. pmid: PMC4443008.
  69. Kalejaiye O, Almekaty K, Blecher G, Minhas S. Premature ejaculation: challenging new and the old concepts. F1000Research. 2017;6:2084. doi: 10.12688/f1000researc h.12150.1. pmid: PMC5717471.
  70. Simons J, Carey MP. Prevalence of Sexual Dysfunctions: Results from a Decade of Research. Archives of sexual behavior. 2001;30(2):177-219. pmid: PMC2426773.
  71. Parelman MA. Regarding ejaculation, delayed and otherwise. J Androl. 2003;24(4):496. pmid: 12826687.
  72. Corona G, Jannini EA, Lotti F, Boddi V, De Vita G, Forti G, et al. Premature and delayed ejaculation: two ends of a single continuum influenced by hormonal milieu. Int J Androl. 2011;34(1):41-8. doi: 10.1111/j.1365-2605.2010.01059.x. pmid: 20345874.
  73. Althof SE. Psychological interventions for delayed ejaculation/orgasm. Int J Impot Res. 2012;24(4):131-6. doi: 10.1038/ijir.2012.2. pmid: 22378496.
  74. Bronner G, Ben-Zion IZ. Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men. J Sex Med. 2014;11(7):1798-806. doi: 10.1111/jsm.12501. pmid: 24674621.
  75. Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours. PLoS ONE. 2014;9(7):e102419. doi: 10.1371/journal.pone.0102 419. pmid: PMC4094516.
  76. Sun C, Bridges A, Johnson JA, Ezzell MB. Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations. Arch Sex Behav. 2016;45(4):983-94. doi: 10.1007/s10508-014-0391-2. pmid: 25466233.
  77. Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, et al. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behavioral Sciences. 2016;6(3):17. doi: 10.3390/bs6030017. pmid: PMC5039517.
  78. Corona G, Ricca V, Bandini E, Mannucci E, Lotti F, Boddi V, et al. Selective serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Med. 2009;6(5):1259-69. doi: 10.1111/j.1743-6109.2009.01248.x. pmid: 19473282.
  79. Nickel M, Moleda D, Loew T, Rother W, Pedrosa Gil F. Cabergoline treatment in men with psychogenic erectile dysfunction: a randomized, double-blind, placebo-controlled study. Int J Impot Res. 2007;19(1):104-7. doi: 10.1038/sj.ijir.3901483. pmid: 16728967.
  80. Hackett G, Cole N, Bhartia M, Kennedy D, Raju J, Wilkinson P. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. J Sex Med. 2013;10(6):1612-27. doi: 10.1111/jsm.12146. pmid: 23551886.
  81. Jenkins LC, Mulhall JP. Delayed Orgasm and Anorgasmia. Fertility and sterility. 2015;104(5):1082-8. doi: 10.1016/j.fertnstert.2015.09.029. pmid: PMC4816679.