Perceived Erectile Dysfunction in a Single Young Male With Multiple Associated Psychological Factors

Erectile dysfunction (ED) is a common presentation in primary care; while psychogenic ED is well-described globally, cases in sexually inexperienced young men where moral incongruence, pornography-related guilt, and childhood trauma are predominant contributors are rarely documented. ED in young males is increasingly recognized as multifactorial, with biopsychosocial complexity, and it can be assessed even in the absence of partnered sexual activity using masturbation-based evaluation. We present the case of a 24-year-old single male with perceived sexual dysfunction: difficulty in sustaining penile erection during masturbation. He engaged in frequent masturbation with pornography, experiencing guilt and moral conflict, and was concerned about "sexual addiction" and anticipated future partnered sexual performance. He reported a background of childhood trauma, a strained paternal relationship with physical abuse, and symptoms of anxiety and low mood. General and systemic physical examinations were unremarkable. Mental state examination further revealed performance anxiety and psychosocial distress, without evidence of an organic pathology. Management aligns with the biopsychosocial framework prioritizing patient-centered psychosocial support, psychoeducation, and cognitive-behavioral strategies within the primary care setting, supplemented by initiation of pharmacotherapy and psychiatric collaboration, leading to notable improvement in psychological and sexual functioning. Clinicians should recognize that psychogenic ED in sexually inexperienced young males may stem from moral incongruence and pornography-related guilt. This case underscores the importance of comprehensive sexual history taking, identification of contributors to psychological distress, trauma history, and sexual behaviors. Early holistic intervention at the primary care level, supported by multidisciplinary collaboration, can facilitate timely recognition and effective management.