Acute Onset Erectile Dysfunction in a 27-Year-Old Male

Case at a Glance

A 27-year-old overweight male presents with a 2-day history of decreased penile rigidity during sexual activity, associated with multiple risk factors including vitamin D deficiency, subclinical hypothyroidism, and sedentary lifestyle.

Patient's Story

The patient reports a sudden onset of erectile dysfunction over the past 48 hours, describing his penis as 'not feeling hard enough as before.' He can still achieve orgasm but notes significantly reduced penile rigidity compared to his baseline function. The patient has a history of excessive pornography use and reports a sedentary lifestyle with poor sleep hygiene. He recently started attending a gym approximately one month prior to symptom onset. The patient denies tobacco or alcohol use and reports no known chronic medical conditions.

Initial Assessment

Physical examination findings not documented in initial presentation. Patient is overweight with known vitamin D deficiency and mild subclinical hypothyroidism. No acute distress noted. Patient appears anxious about the sudden change in sexual function.

The Diagnostic Journey

The patient's presentation suggests multiple potential contributing factors to his erectile dysfunction. Laboratory workup revealed low vitamin D levels and mild thyroid dysfunction (subclinical hypothyroidism). Risk factors identified include obesity, sedentary lifestyle, poor sleep patterns, excessive screen time, and pornography use. The acute onset over 48 hours raised consideration of both psychological and physiological etiologies.

Final Diagnosis

Acute erectile dysfunction, likely multifactorial etiology including: 1) Performance anxiety (psychological component), 2) Vitamin D deficiency, 3) Subclinical hypothyroidism, 4) Lifestyle factors (obesity, sedentary behavior, poor sleep hygiene)

Treatment Plan

Conservative management approach initiated: 1) Sexual abstinence for 72 hours to reduce performance anxiety, 2) Continuation of recently started exercise program, 3) Sleep hygiene counseling, 4) Reduction in pornography consumption, 5) Vitamin D supplementation, 6) Thyroid function monitoring. Patient advised to seek medical evaluation if symptoms persist beyond 2 weeks for comprehensive urological workup.

Outcome and Follow-up

Patient counseled on the likely multifactorial nature of his condition and the importance of lifestyle modifications. Given the acute onset and multiple contributing factors, conservative management with close monitoring was deemed appropriate. Follow-up planned in 2 weeks if symptoms persist, with consideration for formal urological evaluation and additional diagnostic testing including hormonal assessment and vascular studies if indicated.