Erectile Dysfunction Isn’t “Just an Older Man’s Problem”. What if erectile dysfunction is already affecting men in their 20s and 30s—and we’re simply not talking about it?

This study examined sexually active young adult men from the US, focusing on how common erectile dysfunction (ED) actually is and what factors are linked to it. Using validated questionnaires, researchers found that a meaningful portion of young men reported ongoing difficulty getting or maintaining erections, even though they were otherwise healthy and sexually active. ED in this group was not rare or trivial, and it often existed without diagnosed heart disease, diabetes, or major medical illness.

The strongest links were mental health and overall well-being. Men reporting ED were more likely to have symptoms of depression, anxiety, higher stress, poorer self-rated health, and lower sexual confidence. Lifestyle factors also mattered—poorer sleep, lower physical activity, and higher body weight showed consistent associations.

Why this matters: In real life, ED in young men is often an early warning sign—not of aging, but of mental health strain and overall health. This study highlights the need to stop dismissing ED in younger men and start treating it as a meaningful health signal worth addressing early.

Pelvic floor muscle training (PFMT) is often the first thing women are told to try for urinary incontinence—but this massive, in-depth review asked a critical question: How well does it actually work compared with doing nothing?

This paper reviewed dozens of randomized controlled trials involving thousands of women with stress (leakage with coughing, sneezing, lifting heavy things), urgency (leakage when you gotta go, gotta go), or mixed urinary incontinence. Across studies, women who did PFMT were far more likely to report cure or meaningful improvement than those who received no treatment or inactive controls. In many trials, more than half of women doing PFMT improved, compared with far fewer in control groups. Leakage episodes decreased, pad use dropped, and quality of life scores consistently improved.

The strongest results came from structured, supervised PFMT programs, especially those lasting at least 3 months and involving regular, correctly performed contractions. Programs with guidance from trained professionals were the best.

Bottom line: PFMT works, look for a pelvic floor therapist near you if you're struggling. Here are some links to help you find one near you: https://www.aptapelvichealth.org/ptlocator and https://pelvicrehab.com/.

This week, someone asked me, “About 6 years ago I had high dosage radiation for prostate cancer. I am 71 years old, very active and work out vigorously daily. My sex life was good after the treatment but has declined as I my wife has lost interest in intimacy. Hence, I now have problems maintaining an erection due to “use it or loose it”. Meds don’t always work. Is this condition reversible?”. After prostate radiation, erections can decline over time due to gradual blood vessel and nerve changes. Age and other health conditions can also play a role. Even if you're not having regular sex, nighttime erections protect you from worrying about using it or losing it. If you're not getting nighttime erections, it might be due to radiation-related changes or other factors. Sometimes penile rehabilitation—using medications regularly, vacuum devices, or injections—can help preserve blood flow and tissue health. Just as important is addressing relationship dynamics, because intimacy isn’t only physical. A urologist can help you create a realistic, personalized plan.

I love hearing from you, so if there’s a question you’ve been wanting to ask, just let me know. Who knows? Your question might be the one I dive into next!

While I've been working on my revisions for my upcoming book, many of my friends have been busy releasing their books as well.

My colleague and New York Times bestselling gastroenterologist, Dr. Will Bulsiewicz, just released his new book, Plant Powered Plus, which is a fantastic resource for understanding this connection between gut health, inflammation, and how you feel. The book is officially out now, and if you grab it soon, you can still snag the launch bonuses right here.

I had a really important talk about a treatment for erectile dysfunction (ED) that most men haven’t heard of, but it can work even when pills fail—intracavernosal injection therapy. "Intracavernosal injection therapy is a highly effective, time-tested treatment for erectile dysfunction with success rates of nearly 90%. It works when pills fail and can be customized."

Here are some quick takeaways:

If pills haven’t worked for you, don’t lose hope—there are real options out there that can help restore your confidence and quality of life. Check out the full episode to hear all the details!

I had an amazing conversation with journalist and author Michael Gross about why building and keeping muscle isn’t just for athletes—it’s actually key for everyone’s long-term health and happiness! “Strength is a form of connection...your workouts are not just about you. They’re about being able to be with the people you love for as long as you possibly can.”

Some takeaways you’ll love:

To hear why Michael Gross thinks muscle matters for all of listen on Apple Podcasts, Spotify, or here and see why people are commenting, “Great info not only for my penis health and strength but muscle strength as well for longevity. Go hand in hand especially for men. Thank you .”.

Ever wondered if holding your pee could actually make your bladder burst? Check out my new Substack: Can Your Bladder Really Burst from Holding Your Pee? What Every Adult Should Know

In this article, I break down what really happens inside your body when you ignore the urge to pee, the real risks I see as a urologist, and when holding it is uncomfortable—but when it can actually harm your bladder and kidneys.