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FMGE 2010 — Internal Medicine

Q: Most common cause of erectile dysfunction in men under 40:

Drug induced. ***Drug induced*** - In men under 40, **medication side effects** are a significant and often overlooked cause of erectile dysfunction [4]. - Common culprits include **antidepressants** (especially SSRIs), **antihypertensives** (like beta-blockers and thiazide diuretics), and some **antihistamines** [2]. *Vascular* - While vascular issues are the **most common cause overall** in older men, they are less prevalent in younger men unless associated with severe underlying conditions like **uncontrolled hypertension** or **dyslipidemia** [2]. - **Atherosclerosis** and reduced blood flow to the penis are the primary mechanisms, which typically manifest later in life [2]. *Diabetes* - **Diabetes** can cause erectile dysfunction through **peripheral neuropathy** and **vascular damage**, leading to impaired nerve function and blood flow [3]. - Although it can occur at any age, its prevalence as a cause of ED generally **increases with the duration and poor control** of the disease, making it less likely to be the *most common* cause in men under 40. *Psychological* - **Psychological factors** such as stress, anxiety, depression, and relationship problems are **very common** contributors to erectile dysfunction in young men [1]. - However, direct **drug-induced ED** is often a primary or exacerbating factor that should be carefully considered, especially given the widespread use of various medications in this age group [2]. [Practice more Internal Medicine PYQs on OnCourse]

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Most common cause of erectile dysfunction in men under 40: