I’ve spent years treating men with erectile dysfunction – THIS is why the embarrassing problem is on the rise… and the simple solution that could fix it: DR PHILIPPA KAYE

Dan is 24 years old and nearly blue with embarrassment when he sits in my exam room. It can’t reach my eyes. It takes every ounce of effort for him to finally mumble the reason he came here: Dan has trouble achieving an erection.

It may sound surprising. After all, we think erectile dysfunction is something that often happens later in life.

But a surprising number of young men are now struggling with this intimate issue.

The latest data shows that nearly a quarter of young men between the ages of 18 and 40 experience some level of erectile dysfunction.

The reason this is so surprising is that in most cases erectile dysfunction is triggered by underlying chronic diseases such as high blood pressure, high cholesterol or diabetes.

These conditions cause the blood vessels in the penis to narrow, making it difficult to maintain an erection.

That’s why when this problem occurs in my elderly patients, I always check them for hidden, potentially fatal conditions.

But Dan has none of that; His health is fine. His problem is something else entirely, and it’s a problem I see with alarming regularity in men his age now.

What Dan has is body image issues and, frankly, performance anxiety from too much pornography.

We often think of body image concerns as a women’s issue. But research shows that nearly a third of adult men are concerned about their physical appearance.

When we really think about it, this isn’t surprising at all. Just as women are sold unrealistic standards by big fashion companies and reality TV about what they should physically look like, so are men.

Advertisements for something as innocuous as a package holiday often feature men with incredibly toned muscles and strong hair. Meanwhile, social media platforms like TikTok and Instagram are full of steroid-using bodybuilding influencers who claim their bodies are easily attainable.

All of this can make being naked a frightening proposition for young men and can lead to anxiety during sex.

Now add pornography to the mix and the problem increases dramatically.

The extent of pornography use among young men is extraordinary. The Pornhub website alone receives more than 100 million visits per day. Research shows that the majority of teenage boys view pornography regularly, most by the age of 11 or 12, and studies have found that a significant number of young men (one-third to one-third, by some estimates) consider their use to be compulsive or out of control.

This causes real damage.

Pornography does not show ordinary bodies. At the extreme end of the scale, often with disordered eating and drug use, it shows bodies meticulously groomed to look even more extreme.

Concerns about body image and sexual performance are at the heart of anxiety in the bedroom, says Dr Philippa Kaye.

The performances are unreal; actors use drugs and pumps, there are multiple takes, long breaks between scenes. None of this is explained. Instead, what young men absorb—often before they have any real sexual experience—is a pattern that bears absolutely no resemblance to reality.

Altogether, this leaves men feeling self-conscious about their ability to perform during sex to the standard they see during porn, making them less likely to be able to maintain it during sex.

And I want to be very clear about something: This doesn’t mean that this type of erectile dysfunction is ‘all in the head.’

In fact, performance anxiety has a very real impact on the body. When you’re anxious, your body goes into survival mode; It fills with stress hormones and actively diverts blood away from the genitals.

Therefore, worrying about not being able to get an erection makes one physiologically less likely. This confirms the original concern. This makes the next attempt even worse. This is a self-reinforcing vicious cycle, and it is biological, not imaginary.

What can be done? Quite a lot, as it were.

Of course, there are medications that can help. Viagra and Cialis are two cheap and effective erectile dysfunction tablets that can be bought from pharmacies in the UK.

But they don’t work for everyone and don’t fix the underlying cause of the problem.

GP, author and broadcaster Dr. Philippa Kaye

Instead, the first step is to simply name what is happening. I saw this in Dan. Once he was able to voice his concerns, I was able to explain to him how normal his feelings were and how he was setting unrealistic, punitive expectations for himself. This reduced his anxiety considerably. Therefore, it is always beneficial to report the issue to your doctor; I appreciate that this may seem embarrassing to you, but we’ve seen and heard these things before.

But there are other steps.

For men with high pornography use, it is important to reduce this use. This may help with anxiety, but it will also help in other ways. There is now good evidence that excessive porn consumption desensitizes the body to sexual stimulation; This means physical intimacy with a partner may not be enough to arouse them.

Avoiding porn whenever possible will almost certainly increase libido and increase the likelihood of erections.

Staying present also helps. Not as some vague wellness concept, but for one specific reason: arousal requires attention, and if your attention is focused on watching yourself perform—if you mentally step out of your body and criticize everything—arousal collapses.

Psychosexual therapy can help with this. Through a series of structured exercises, couples learn to take penetration and orgasm completely off the table by focusing solely on touch and physical sensations. It feels counter-intuitive. But it works. The brain learns to associate intimacy with pleasure rather than pressure. The script is being rewritten.

Going to a sex therapist can feel scary or embarrassing. But you would see a physical therapist for a knee injury, so why should this be any different?

Dan left my exam room looking much less purple than when he arrived. He had an explanation. He had a plan. And he was reassured that there was nothing fundamentally wrong with him.

No. What about the culture that tells young men what sex should be like? This is a completely different topic.