Erectile dysfunction (ED) is one of the most common yet underestimated conditions among men of all ages. It is not merely a physical issue: it often involves psychological, emotional and relational aspects. In Milan, where the demand for specialist services is particularly high, more and more men are seeking quick, clear and professional answers to address a condition that can deeply affect their quality of life.
What is erectile dysfunction?
Erectile dysfunction is the persistent or recurrent inability to achieve or maintain an erection sufficient to carry out a satisfactory sexual intercourse.
It should not be confused with occasional erection difficulties, which may depend on stress or fatigue: ED is considered such only if the problem persists for at least 3 months.
Erectile dysfunction in Milan: why it is increasingly discussed
Milan, the Italian capital of specialist medicine, is seeing a growing number of men — including young men — seeking andrology, urology or sexology consultations.
The reasons are clear:
- Stressful lifestyle and intense work rhythms.
- Greater awareness of sexual health.
- Access to advanced medical centers and experienced professionals.
- Increase in cases of performance anxiety, especially among men under 35 years old.
The city also offers rapid diagnostic services and modern treatments, including pharmacological therapies, psychological pathways, hormonal therapies, shockwave treatments, and the integration of high-quality nutraceuticals.
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Causes of erectile dysfunction
Erectile dysfunction (ED) can have numerous causes, often interconnected with one another. Medicine classifies these causes into three main categories: physical, psychological, and mixed. Understanding them is essential to identify the most effective treatment, especially in an advanced clinical setting like Milan, where diagnosis is increasingly personalized thanks to access to specialists and cutting-edge technologies.
Physical causes of erectile dysfunction (organic causes)
Physical causes are among the most common, especially with advancing age, but today they also affect men under 40.
In general, anything that compromises blood flow, hormonal function, or nerve transmission can lead to ED.
Here are the main ones:
1. Vascular problems (hypertension, atherosclerosis)
An erection is a vascular process: it requires blood to flow quickly into the corpora cavernosa of the penis.
Conditions such as:
- arterial hypertension
- atherosclerosis
- high cholesterol
- atheromatous plaques
- cardiovascular diseases
cause an insufficient blood supply, preventing a stable erection.
Important: erectile dysfunction can be an early warning sign of cardiovascular problems.
2. Diabetes (type 1 and type 2)
Diabetes is one of the most common physical causes of ED.
It leads to erectile dysfunction through three main mechanisms:
- microangiopathy: damage to the small blood vessels
- diabetic neuropathy: damage to the nerves responsible for erection
- reduced testosterone levels
ED can also appear in young men with diabetes, especially when blood sugar levels are poorly controlled.
3. Low testosterone (hypogonadism)
Testosterone is essential for:
- sexual desire
- erectile function
- energy
- mood
When levels drop (due to age, stress, obesity, or endocrine disorders), symptoms may include:
- reduced libido
- difficulty maintaining an erection
- persistent fatigue
- loss of muscle mass
In Milan, more and more men undergo hormonal evaluations for these symptoms.
4. Neurological diseases
The nerves that regulate erection can be damaged by:
- multiple sclerosis
- Parkinson’s disease
- stroke
- neuropathies
- spinal injuries
- pelvic surgery
When nerve signal transmission is disrupted, an erection may fail to occur or may be insufficient.
5. Overweight and obesity
Excess body weight affects erectile function in three key ways:
- reduces testosterone levels
- worsens circulation
- increases inflammation and insulin resistance
Men with obesity have up to three times the risk of developing ED.
6. Smoking
Smoking narrows blood vessels and damages the endothelium (the lining of blood vessels), drastically reducing blood flow to the penis.
It is one of the most frequent causes of ED among young men in Milan.
7. Excessive alcohol intake
Alcohol temporarily reduces sensitivity and interferes with the neurotransmitters involved in erection.
Chronic abuse, however, can lead to permanent ED.
8. Drug abuse
Cocaine, cannabis, ecstasy, and other substances can alter:
- blood flow
- hormones
- arousal capacity
- nerve transmission
These substances often trigger ED even in young men aged 18–25.
9. Prostate problems
Conditions such as:
- enlarged prostate (BPH)
- chronic prostatitis
- prostate cancer
- prostate surgery (e.g., prostatectomy)
can affect the nerves and tissues responsible for erection.
10. Erectile dysfunction caused by medications
Many medications can affect erection, including:
- antidepressants (SSRIs, SNRIs)
- beta-blockers
- diuretics
- blood pressure medications
- statins
- antipsychotics
- prostate medications
In these cases, a specialist can evaluate therapeutic alternatives or supportive strategies.
Psychological causes of erectile dysfunction
The psychological component is often underestimated, yet it plays a central role in most cases — especially among young men in Milan, where stress and work pressure are high.
1. Performance anxiety
One of the most common causes in men under 35.
It creates a vicious cycle:
fear of failure → tension → weak erection → more fear
It can be treated very effectively with psychologists and sex therapists.
2. Stress (very common in Milan)
Competitive work environments, fast-paced lifestyles and social pressure can:
- reduce libido
- activate the sympathetic nervous system (which inhibits erection)
- create difficulties in maintaining arousal
3. Depression
Depression affects dopamine levels and motivation, reducing:
- sexual desire
- sensitivity
- erectile capacity
Even antidepressant medications can temporarily worsen ED.
4. Relationship problems
Emotional distance, conflicts, jealousy and poor communication are all factors that can trigger erectile dysfunction even in men who are physically healthy.
5. Emotional or sexual trauma
Psychologically significant events — even those from the distant past — can affect sexual response and contribute to persistent ED.
Mixed causes of erectile dysfunction
Most cases of ED are mixed, meaning they arise from a combination of factors:
- A physical issue (e.g., unstable erection) can generate anticipatory anxiety.
- A drop in testosterone can increase mental insecurity.
- A single episode of “failure” can create a psychological block even if the initial cause was physical.
- Emotional stress can worsen pre-existing vascular conditions.
Specialist centers in Milan often adopt a multidisciplinary approach, combining:
- blood tests
- vascular diagnostics
- psychological consultations
- hormonal evaluation
- lifestyle interventions
Symptoms of erectile dysfunction
ymptoms can vary from one man to another:
- Difficulty achieving an erection
- Weak or unstable erections
- Erection that fades during intercourse
- Reduced frequency of morning erections
- Decreased sexual desire
→ When the symptom is recurrent, a specialist evaluation is essential.
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Erectile dysfunction in young men
Contrary to common belief, ED is increasingly affecting men under 30.
The main triggering factors are:
- Performance anxiety
- Excessive pornography use (which alters real sexual arousal)
- University or work-related stress
- Unhealthy lifestyle habits (smoking, alcohol, low physical activity)
- Hormonal imbalances
Milan, being a high-pressure and fast-paced city, amplifies stress, competition and emotional tension. It is not uncommon for Milanese andrologists to report cases even in 18–20-year-old men.
Erectile dysfunction during intercourse
One of the most frequent signs is the sudden loss of erection during penetration or just before it.
The possible causes include:
- Anxiety or distraction
- Fear of disappointing the partner
- Sudden drop in desire
- Circulation problems
- Excessive mental stimulation (overthinking)
This symptom is often treatable with a combination of psychological techniques and medical support.
Erectile dysfunction and anxiety
Anxiety is now one of the main causes of erectile dysfunction, especially in Milan, where fast-paced lifestyles and high expectations easily generate tension.
Anxiety can:
- block the erection
- cause loss of erection during intercourse
- reduce sensitivity
- create a vicious cycle (“fear of failing → failure → more fear”)
A proper diagnosis often helps resolve the issue within just a few psychological or sex therapy sessions.
Erectile dysfunction caused by medications
Some medications can impair erection. The most well-known include:
- SSRIs and SNRIs antidepressants
- beta-blockers
- blood pressure medications
- prostate medications
- antipsychotics
In these cases, the specialist may adjust the therapy or introduce supportive treatments to counteract the side effects.
Remedies for erectile dysfunction
The solution always depends on the underlying cause. In Milan, a wide range of personalized treatment pathways is available.
1. Medical treatments
- PDE5 inhibitors (sildenafil, tadalafil, vardenafil)
- Hormone therapy (when testosterone is low)
- Penile shockwave therapy (an advanced treatment offered in many centers in Milan)
- Intracavernosal injections
- Penile prostheses (reserved for severe or refractory cases)
2. Natural remedies
- Red ginseng
- Maca root
- Ginkgo biloba
- Tribulus terrestris
- L-arginine and citrulline
Note: These must be taken responsibly and under medical supervision.
3. Supplements for erectile dysfunction
Supplements can improve microcirculation, libido, and sexual energy. The most commonly used in Milan include:
- L-arginine
- Citrulline
- Zinc
- B vitamins
- Ashwagandha (for anxiety and stress)
- Fermented red ginseng
They must be chosen in certified, high-quality formulations.
4. Psychological remedies
- Anxiety management
- Cognitive-behavioral therapy (CBT)
- Sex therapy
- Mindfulness-based techniques
- Breathing training
These are often the most effective remedies in young men.
5. Lifestyle improvements
- Reduce stress
- Improve sleep quality
- Increase physical activity
- Reduce alcohol and smoking
- Follow a Mediterranean diet (source: Harvard Health)
Erectile dysfunction: when to consult a specialist in Milan
You should consult a urologist or andrologist in Milan when:
- the problem has persisted for more than 3 months
- erection quality is worsening
- there is pain, curvature, or trauma
- hormonal imbalances are suspected
- you have diabetes or hypertension
- the issue interferes with the relationship
- you are taking medications that may cause ED
In Milan, many centers offer rapid diagnosis, comprehensive blood tests, penile Doppler ultrasound, and combined medical–psychological treatment pathways.
Immediate online remedy with InfinityDoc.
FAQ – Frequently Asked Questions about Erectile Dysfunction
Yes. In most cases, it is fully treatable with a medical, psychological, or combined approach.
It is becoming increasingly common. Milan is seeing a rise in cases linked to anxiety, academic/work stress, and unhealthy lifestyle habits.
They can help, but they must be chosen carefully and do not replace medical diagnosis.
es, if they are high-quality and taken under medical supervision.
Avoid unregulated or uncertified products.
Absolutely yes: it is one of the most common causes, especially in men under 40.
Yes. Stress and overthinking are among the primary causes.
Yes, many medications can affect erectile function. A specialist evaluation is recommended.
When the problem persists, worsens, or affects quality of life or the relationship.
Yes: it often signals cardiovascular issues or diabetes.
Erectile dysfunction is the inability to maintain an erection firm enough to complete sexual intercourse satisfactorily.
It is a medical condition that requires proper attention.
No. Although physical (organic) causes are more common with age, ED can be partially or entirely psychological, especially performance anxiety, which is frequent among young men.
If the difficulty occurs mainly during intercourse, but the initial erection is good, the cause may be psychological (loss of focus or anxiety) or due to venous leakage.
A specialist diagnosis is necessary.
PDE5 inhibitors (such as Sildenafil or Tadalafil) should be taken 30–60 minutes beforehand, although Tadalafil — known as the “weekend pill” — can remain effective for up to 36 hours.
