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.

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........

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