Too Young for ED? What To Do When Erectile and Sexual Dysfunction Affect Young Men

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in medical and urology care and the best urology humor out there.

In this segment,  Dr. Mistry and Donna Lee discuss erectile dysfunction in young men. We all know ED is an issue many men face as they age. But what happens when you have symptoms of ED or sexual dysfunction in the "prime" of your sexual years? Dr. Mistry explains common complaints of young men, many of whom discover problems when they first begin to masturbate and/or have sex. Some of these issues are surprisingly simple to address, like frenulums that are too tight. Others may seem like physiological issues, but may in fact stem from psychological or sociocultural factors that can be treated with education and/or sex therapy. More than anything, if you're young and healthy, your sex life should be, too. If something seems wrong, it's always worth consulting with your primary care doctor and/or a urologist. Email our practice anytime with your anonymous questions and we'll get back to you!

This episode was previously aired on Jan. 9, 2021. Don’t forget to like, subscribe, and share us with a friend! As always, be well!

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!

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Transcript

Speaker 1: 0:09
Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry: 0:18
Hello and welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my unflappable cohost, Donna Lee. Unflappable.
Donna Lee: 0:22
Did you have a hiccup right there in the middle?
Dr. Mistry: 0:29
Perhaps.
Donna Lee: 0:30
Couldn't think of another word [inaudible].
Dr. Mistry: 0:30
Perhaps. I'm Dr. Mistry. I'm a board certified urologist, and this is a men's health show. Urology is the medical special subspecialty that is a surgical subspecialty. We train for between 5 and 6 years, including oftentimes up extended period of time training in general surgery. We learn about hormonal therapy and men's health dealing with the genitourinary system, including the kidney, the bladder, the prostate. We deal with erections. We deal with a variety of things like prostate cancer, bladder cancer, testis cancer. And when you step it up a notch like we do, when you step it up a notch, you realize that the genitals are not disconnected from the rest of the body.
Donna Lee: 1:08
They're not?
Dr. Mistry: 1:09
Isn't that weird?
Donna Lee: 1:10
They're not on their own island?
Dr. Mistry: 1:11
They're not on their own island. Somehow, you know, the knee bone is connected to the leg bone connected to the pelvic bone.
Donna Lee: 1:16
It's all connected to the penis bone.
Dr. Mistry: 1:18
And that's really, of course , and that's what has driven this practice, this show, the relationships we have with our patients is understanding the interconnectedness of health with nutrition, with supplements, with exercise, with biomechanics. We look at how does your cardiovascular health affect your fertility? We looked at how your psychological health can affect your sexuality. We look at how your bowel health can affect your skin. These are the things that we look at and try to put them together in a picture that, you know, allows you to be your best self.
Donna Lee: 1:48
Like a customized puzzle.
Dr. Mistry: 1:49
Well, we're trying to.
Donna Lee: 1:50
Because everybody's different.
Dr. Mistry: 1:52
And so many people come to us and, and they'll tell us they have a problem that I'll have an obvious solution for that won't have any new with urology, you know. Maybe stop using that soap, you know?
Donna Lee: 2:04
It's like, "My elbow hurts when I do this doctor." Well don't do that.
Dr. Mistry: 2:06
That's great . That's a great example. You know what I thought we'd talked today about Donna? I thought we talk about erectile dysfunction in the young man.
Donna Lee: 2:14
Oh. Cause we do treat a lot of that.
Dr. Mistry: 2:16
That's right. And the young man with erectile dysfunction, like the 20 year old, we are very fortunate. We are very closely aligned with the health center at University of Texas. And so they send us virtually all of their urology patients.
Donna Lee: 2:29
That's a lot.
Dr. Mistry: 2:29
So when they have a kid with erectile dysfunction they get sent to us.
Donna Lee: 2:33
Right. Is it, and I know that we've talked about it like a long time ago, year ago, some of these athletic guys, the super athletes for these schools and they're taking some testosterone and that might mess with their erections?
Dr. Mistry: 2:44
I mean, I think that there's a machismo that leads to those kinds of drug abuse issues. But , you know, most of them are not like that.
Donna Lee: 2:52
I think I just implied something illegal.
Dr. Mistry: 2:53
Yes. You sure did.
Donna Lee: 2:54
I'm so sorry about that. UT, I didn't mean...
Dr. Mistry: 2:56
Oh, my Lord.
Donna Lee: 2:57
Sorry, coach.
Dr. Mistry: 2:58
She's from Lockhart, coach.
Donna Lee: 2:58
Wow. I went to Texas State and there was no illegal activity.
Dr. Mistry: 3:01
Oh man. So the young man with erectile dysfunction is unique from the older man. In the older man, we're looking at more neurologic, more vascular kinds of issues. We're looking at, their evaluations include making sure their heart is okay, making sure their sensation is okay, making sure their testosterone is okay. This 19 year old kid that comes to us who's unable to have intercourse--that's a different, that's a different kind of issue. Oftentimes there's something anatomic. You know , this past week I took care of a very young kid who tried to have intercourse for the first time, and it hurt like anything.
Donna Lee: 3:38
Oh no!
Dr. Mistry: 3:38
He lost his erection, you know. Whoever he was having sex with really, you know, was like pretty upset.
Donna Lee: 3:45
They're both scarred for life!
Dr. Mistry: 3:45
You know what I'm saying? I mean, it was , it was a very bad, you know, failure to launch, I say. And so he saw his , the doctor at UT, they were sent to us, and it was just a very easy thing.
Donna Lee: 3:54
What?
Dr. Mistry: 3:54
The foreskin--he was uncircumcised--the very bottom part of the foreskin where the frenulum, it's called a frenulum, even he described as the guitar string, like is under your tongue. That's right. So the frenulum was too tight. And so when, you know, he went in, the thing pulled and ouch!
Donna Lee: 4:10
Oh, that made my te-te hurting. I don't have a te-te.
Dr. Mistry: 4:13
I don't have a te-te, but it hurt. Some other things I learned that, and how do people figure this out is usually they masturbate, but this kid didn't masturbate when he was younger. So he didn't stretch the thing...
Donna Lee: 4:22
How does that happen?
Dr. Mistry: 4:23
I mean, it. So he was scarred. He was scarred.
Donna Lee: 4:27
I bet. I bet she was scarred. Should we call her?
Dr. Mistry: 4:27
I was like, you know, I can, I can easily fix that thing. We do. What's called a frenulectomy here, or frenulotomy here in the office, it takes me about 10 minutes. We just come of kind of snip that little guitar string and it doesn't hurt...
Donna Lee: 4:39
Are you sure?
Dr. Mistry: 4:39
...me at least. And it works like a charm. And you know how I sell it to the guys?
Donna Lee: 4:46
That they won't hurt during sex?
Dr. Mistry: 4:47
Once you cut the guitar string, you get two inches.
Donna Lee: 4:50
Oh yeah. And some more. And some lady parts...or boy parts, whatever.
Dr. Mistry: 4:58
Yeah. Oh , okay. So in any case, this was an interesting cause of it, but to get him over this issue. So, I see a number of men between 18 and 35, let's say who are afraid, really afraid of having sex.
Donna Lee: 5:16
Why? Because of the pain?
Dr. Mistry: 5:17
They don't know what's gonna happen. Like they don't know where to put it, how to aim it.
Donna Lee: 5:20
Oh really?
Dr. Mistry: 5:21
Yeah. I mean, if you're like a 35 year old virgin, and you're just about to get married and you don't know what's going to happen. I mean, you know, who, who knows?Donna Lee: 5:27
And I bet it's somewhat of a cultural thing, because we have a lot of patients from other lands.
Dr. Mistry: 5:32
That's right.
Donna Lee: 5:32
And they are in marriages that are arranged.
Dr. Mistry: 5:34
Perhaps.
Donna Lee: 5:35
And they probably haven't had any hmm-hmm.
Dr. Mistry: 5:38
This makes up a large portion of the patients that we see. We get, we get them referred when they're trying to have babies, and like, they're like, "Well, what's going on? What's the problem?" Why haven't we been able to get pregnant?" "Well , you know, we married for seven years. We can't have sex." And so the erectile dysfunction in that group of people, right, it's multifactorial, it's psychological, but not psychological erectile dysfunction. It's psychological, just kind of aversion, we call it, to intercourse. And so then we have a program for those people, too . We have a sex therapist, we have pelvic floor physical therapy. And then we use, we utilize like different tools.
Donna Lee: 6:10
Like flashlight.com.
Dr. Mistry: 6:11
That's right, flashlight.com. They don't, they're not a sponsor.
Donna Lee: 6:14
They're not. That's true.
Dr. Mistry: 6:14
I'm just saying. And maybe just stick to their therapetic things, and maybe stay away from their more colorful items.
Donna Lee: 6:22
They have a great website!
Dr. Mistry: 6:23
Stop looking at the website. That's an office computer. And so we, yeah--could you imagine if we had to have filters on our office computers?
Donna Lee: 6:29
Oh boy, no.
Dr. Mistry: 6:29
...all of our research would go down the drain. Our own website would be banned!
Donna Lee: 6:34
Is that what we're calling it? Research?
Dr. Mistry: 6:35
Research To our own patients, we call it a prosthetic vagina, something that looks and feels like a vagina that patients can feel comfortable kind of utilizing and practicing...Donna Lee: 6:45
And it doesn't nag you! Sorry.
Dr. Mistry: 6:46
Oh my God, you just shot their sales up 600%.
Donna Lee: 6:48
It doesn't talk that guys! Go and get your one!
Dr. Mistry: 6:51
What kind of feminist are you?
Donna Lee: 6:53
I'm the worst kind.
Dr. Mistry: 6:55
That's the payment. But , you know, if you have a son or you yourself are, you know, have a situation in which you think erectile dysfunction or some type of sexual dysfunction in the young patients is existing, seeing a urologist or any urologist that specializes in sexual function is like the best, best gift you can give to them, because they're not going to be able to talk to about anybody else. They're not talking to their buddies, you know, on the football team about their erectile dysfunction.
Donna Lee: 7:18
Right. And they're not talking to their parents.
Dr. Mistry: 7:20
And they're not talking to the girlfriend!
Donna Lee: 7:21
Poor girl.
Dr. Mistry: 7:22
You know what I'm saying? So, so on and on , if you do come across or you're suffering from it , the kinds of things that we do , if it's a real severe erectile dysfunction that we think is physiologic, we can do specialized ultrasound testing to make sure that the arteries and veins of the penis are intact. If it's something structural like tight foreskin or a tight frenulum or, some men , I've even met several 17-year-olds where a very severe curvature of the penis was present, that should have been picked up when they were babies was missed. It's called a chordee.
Donna Lee: 7:58
Oh. I didn't know babies could have that.
Dr. Mistry: 7:59
Yeah. Oh, you know , it comes in all shapes and sizes. And so a congenital , curvature could be causing it. There can be psychologic issues prior history of abuse, prior history of, you know , how, you know, culturally raised, something about religious reasons that make them want to avoid intercourse. And so that's why we have sex therapy on staff. A lot of guys will offer, will suffer from performance anxiety. So this week I had a kid who was having trouble getting an erection and he had trouble once, and then ever since then, it's been, you know, no luck. And then he'll go in and they'll try to find Viagra off some website or some, you know.
Donna Lee: 8:43
Oh, don't do that!
Dr. Mistry: 8:44
...and they'll just get it mailed to them. And it just makes the problem worse because now they're using a crutch. So they really believe they really do have a broken leg, you know ?
Donna Lee: 8:52
Right, and you don't know what's in that thing you've got overseas , that pill. Don't do that.
Dr. Mistry: 8:56
And so, and so for all those reasons , if you're under the age of 35 and you have erectile dysfunction, you know, I think that your evaluation should go beyond the primary care doctor and you should really see a sexual medicine specialist because you know, your problem's not, it may be fixed by Viagra or Cialis, but maybe it shouldn't be fixed by Viagra or Cialis.
Donna Lee: 9:16
Right. Because that's just a treatment.
Dr. Mistry: 9:18
Maybe we need to figure out what's going on because there's a bandaid and there's a source. And so that's the kind of stuff that we'll do. About three years ago , I had a 26 year old guy who had a pituitary adenoma , which is a non-cancerous , hormone-secreting tumor of the pituitary gland, which is in the brain causing severe erectile dysfunction and low libido. And he'd been using Viagra for like four years. I was like, "Nobody ever told you that 26 year old men shouldn't have erectile dysfunction?"
Donna Lee: 9:49
Yeah. What doctor did he go to?
Dr. Mistry: 9:51
This is the highlight of your life! You should be knocking it out of the park!
Donna Lee: 9:54
You should banging things left and right!
Dr. Mistry: 9:58
Very good. Well , if you want to see us , Donna, how do people get ahold of us?
Donna Lee: 10:01
You can call us during the week at (512) 238-0762. And you can also send your questions to armormenshealth@gmail.com. And our website is armormenshealth.com. Listen to our podcasts wherever you catch podcasts for free. And if you have any questions, Dr . Mistry is happy as all get out to answer. So thank you so much. I'm going to let Dr. Mistry eat that bite right there.
Speaker 1: 10:24
The Armor Men's Health Hour is brought to you by Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.