In an otherwise healthy 20-year-old man, psychological factors are the most common cause of impotence. Stress, relationship problems, or "performance anxiety" can all cause a man to have difficulty getting or keeping an erection. These problems can be unpredictable -- sexual function may be perfectly normal one day, then miserable the next. One telltale sign of psychological impotence is that normal erections occur during sleep or first thing in the morning. The good news is that psychological causes of impotence tend to get better on their own over time.
Another factor may be substance abuse. Alcohol, narcotics and anabolic steroids can all interfere with sexual drive and performance.
Rarely, young men can develop more serious causes of impotence (also known as erectile dysfunction or ED). For example, serious trauma or medical conditions can lead to blood vessel or nerve damage. Hormone problems can also affect both sexual drive (libido) and function. In contrast to psychological impotence, ED caused by one of these physical conditions tends to occur with each sexual encounter, and tends to get worse over time.
It's also importance to recognize that erectile dysfunction is quite different than other sexual conditions affecting young men, such as premature ejaculation.
Be sure to see your health care provider if you experience sexual problems that last more than a few weeks. He or she may be able to give you some reassurance, or begin a medical evaluation to rule out more serious causes of erectile dysfunction. Even if impotence is caused mostly by psychological problems, appropriate counseling and treatment can be very helpful.
