Young, Single, Not Ready to Mingle: Relationships, Mental Health, ED

A single man in his late 20s occasionally dates but hasn't been on a date in some time. He has sex infrequently. That's been the case for a few years, maybe about a decade.

He has developed depression and anxiety. He has struggled with those mental health issues for a while, and now he has problems getting erections. When he does get hard, his penis doesn't remain that way for long, certainly not long enough to enjoy penetrative intercourse.

He's been saying to himself, "Man, I've been single for so long. I feel broken because of my mental health issues, and now I can't even get it up or keep it up. Nobody is going to want to be with me."

Any young guy experiencing mental health issues and erectile dysfunction (ED) should know there's hope. Their situation is not as dire as it might seem, according to Ravi Hariprasad, M.D., M.P.H., a psychiatrist with Intuitive Psychiatry in San Francisco.

"His first step was recognizing the problem and seeking help and taking the steps required to make the situation better," Hariprasad said about the hypothetical young man.

Relatively young single men who suffer from both a chronic mental health condition, such as anxiety or depression, and ED are not alone, contrary to what they might fear. There's not only hope for them, but also help and coping strategies available.

Risk factors for depression, anxiety and ED

Authors of a study first published in 2020 in the Journal of Urology found an association between relationship status, mental health and ED. The mental health and ED link appeared common among a sample of 2,660 sexually active men between 18 and 31 years of age. About 14 percent reported some form of ED. Anxiety and tranquilizer use were associated with greater odds of moderate-to-severe ED; antidepressant use was associated with more than three times the odds of moderate-to-severe ED. Married men and those with partners were 65 percent less likely than single guys to experience it in moderate-to-severe form.

"This information may not necessarily function the same way when reversed and used as a predictive model of whether a young single man may be at risk of having or developing ED of any severity," according to Joshua Poole, M.D., a psychiatrist in California who works with Open Mind Health, a virtual mental wellness network. "It more so tells us that those surveyed who were already partnered were less likely to have moderate to severe ED."

We don't yet have definitive data clarifying just how relationship status, mental health and sexual dysfunction relate to each other, however, Poole said.

"Clinically, I have witnessed that the quality of the relationship frequently has more to do with sexual dysfunction than the presence or absence of a relationship," he explained. "There are many instances where a relationship can be the source of both mental health issues and sexual dysfunction. In speaking to therapists who specialize in sex therapy, I have often been told that a great deal of sexual dysfunction is actually the result of emotional dysfunction in the dynamic of a relationship."

For young men, the major risk factors for developing anxiety and depression include genetics, stress, and drug and alcohol problems, said Eric Yarbrough, M.D., a psychiatrist based in New York City. Like Poole, though, he doesn't consider the relationship between partner status and mental health clear-cut.

"Some people have relationships which are healthy and supportive," he said. "Others might have relationships which cause them stress and do more harm than good. There are reasons to be single and reasons to be in a relationship, but they are highly individual and relative."

Nevertheless, several factors might account for the association observed in the study.

Ways mental health interferes with sexual health

Anxiety and depression can both lead to low libido, ejaculatory dysfunction and ED, Poole explained.

Those mental health conditions, Hariprasad suggested, can keep someone from being present and can interfere with their ability to focus when trying to have sex.

"This can make it more difficult for men to achieve and maintain an erection, leading to erectile dysfunction," he said in an email. "Additionally, single men may be more likely to be in sexual relationships with less familiar partners, which can lead to increased feelings of anxiety, further exacerbating erectile dysfunction."

There's nothing mysterious regarding the comparatively lower prevalence of sexual dysfunction among men in emotionally supportive, multidimensional and close partnerships vis-à-vis young single men, Hariprasad said.

"I've seen over these years of our Tinder culture—our hookup culture—people are losing these other dimensions of friendship and intimacy in relationships, and that's leading to some of this difficulty," he said in reference to struggling single men. "Contrary to what the media says, the novelty of having sex with a partner you don't know is not universally arousing. It can be terrifying to some, and it can activate feelings of insecurity and anxiety in others, none of which are very sexy."

In contrast, as Hariprasad stressed, arousal can emerge from intimacy.

Conversely, frequent masturbation and excess ejaculation can exacerbate the cycle of mental health issues contributing to relationship difficulties and vice versa, he said, adding that porn consumption often gets paired with incessant masturbation, and that can cause another vicious cycle. Watching a lot of porn can desensitize someone to the amount of stimulus needed for arousal, which could result in ED, Hariprasad explained.

"Often, people are not watching the entire clip," he said. "They're just fast-forwarding to the components that are highly arousing, and that's leading to an inappropriate mental patterning of the sexual response cycle that's not often conducive to a normal sexual response cycle with a partner."

Therapy and coping strategies

So what can the young, single guy dealing with ED as well as anxiety and/or depression do to address his problems?

Yarbrough would advise the man to prioritize treating his anxiety and depression since the conditions can affect myriad facets of life, from work to family to friendships to romance. He should also see a primary care physician to rule out any potential health problems that could be causing the mental health difficulties.

"After all of this, a person can explore their sexual history and views on sex to understand how they might be affecting his ability to maintain an erection," he said.

Poole cautioned that the gold standard for treating both anxiety and depression has a reputation for contributing to sexual dysfunction. These are typically antidepressants derived from the family of medications that includes selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

"It's a tricky thing when the treatment for a problem can also cause the problem," he acknowledged.

If ED results as a side effect of antidepressant medication, Poole recommended decreasing the dose or switching to a medication that doesn't worsen the patient's mood disorder.

Nonpharmaceutical strategies, including practicing breathing techniques to help in the moment and writing a journal to identify and alter spiraling negative thoughts, can help some people cope with anxiety and depression.

Certain physical activities, done regularly, have been shown to be potentially helpful, such as the following:

• Practice stress-management techniques, such as meditation and yoga
• Engage in mindful movements like tai chi
• Adopt a proper sleep schedule
• Avoid excess caffeine
• Eat a balanced diet

CBD oil might be a mild therapeutic option for some folks struggling with anxiety and depression. Assistance from professionals in the form of cognitive behavioral therapy (CBT) can be a talk therapy tool worth exploring to pinpoint triggers and manage symptoms.

A new lens for sexual behavior

Hariprasad affirmed talk therapy and lifestyle changes as treatment possibilities.

"Then, in parallel, we'd need to change your sexual behaviors and hygiene so that you're more likely to succeed," he said.

Depending on the person, that could involve cutting back on masturbation and time spent viewing porn.

Since a lack of exercise for the muscles in the pelvic floor can make them lax, potentially leading to problems like premature ejaculation and ED, Kegel exercises can be useful, he added.

"A lot of literature and common knowledge has been about Kegel exercises for women," Hariprasad said. "And what's not appreciated is that the same set of exercises can be used by men to enhance their performance. I think it's one of the single-most helpful things that someone could do as a practice, is [to] learn to isolate those muscles and exercise them so they're stronger."

Doing Kegels, together with exercise for the abdominal muscles, might enable men to improve the quality of their erections and their ejaculatory control, he added.

Hariprasad further suggested that guys in their 20s and 30s could begin to address the entanglement of issues that stand in the way of good psychological health, erections and relationships by learning how to form close, meaningful connections.

"That means forming friendships and then learning to have intimacy in those friendships—not necessarily seeking sexual encounters—and allowing the sexuality to arise organically from within those intimate, connected, safe relationships," he said.

"Taken all together, this strategy has helped countless men I've worked with over the years reboot their sexual life and get their life and self-esteem back in order. But [men need] to understand that the situation is hopeful. [The work] just needs to be done methodically and patiently," Hariprasad concluded.

It's not always easy for men to seek help, especially for something as personal and sensitive as erection troubles. Plus, a lot of people don't have a therapist they see regularly, so it's not always intuitive to take that first step. Video visits have become a viable option for most people, and more physicians and therapists have added them as a service. Giddy telehealth makes it easy to get connected to a qualified healthcare professional who can help with a variety of mental and physical health conditions.