{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:48:15Z","timestamp":1777855695622,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Mens Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>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 \u201csexual addiction\u201d 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.<\/jats:p>","DOI":"10.1177\/15579883261441860","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T04:42:11Z","timestamp":1776055331000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceived Erectile Dysfunction in a Single Young Male With Multiple Associated Psychological Factors"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9161-6155","authenticated-orcid":false,"given":"Beatrice","family":"Jee Ngee Ling","sequence":"first","affiliation":[{"name":"Kampung Bandar Health Clinic, Jalan Kurau, Kuala Langat, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-2332","authenticated-orcid":false,"given":"Shaiful Bahari","family":"Ismail","sequence":"additional","affiliation":[{"name":"School of Medical Sciences Health Campus, Universiti Sains Malaysia Kubang Kerian, Kota Bharu, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Cassioli E. Tarchi L. Rossi E. Faldi M. Dani C. Giuranno G. Siviglia S. Baroncelli A. Maggi M. Vignozzi L. Giraldi A. Ricca V. Castellini G. (2024). Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology. The Journal of Sexual Medicine 21(7) 635\u2013647. https:\/\/doi.org\/10.1093\/jsxmed\/qdae058","DOI":"10.1093\/jsxmed\/qdae058"},{"key":"e_1_3_2_3_1","doi-asserted-by":"crossref","unstructured":"Dewitte M. Bettocchi C. Carvalho J. Corona G. Flink I. Limoncin E. Pascoal P. Reisman Y. Van Lankveld J. (2021). A psychosocial approach to erectile dysfunction: Position statements from the European Society of Sexual Medicine (ESSM). Sexual Medicine 9(6) Article 100434. https:\/\/doi.org\/10.1016\/j.esxm.2021.100434","DOI":"10.1016\/j.esxm.2021.100434"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"Diao X. Zhang C. Wang Z. (2024). Age-dependent effects of homocysteine on erectile dysfunction risk among U.S. males: A NHANES analysis. American Journal of Men\u2019s Health 18(5) Article 278065. https:\/\/doi.org\/10.1177\/15579883241278065","DOI":"10.1177\/15579883241278065"},{"key":"e_1_3_2_5_1","unstructured":"Jacobs T. Geysemans B. Van Hal G. Glazemakers I. Fog-Poulsen K. Vermandel A. De Wachter S. De Win G. (n.d.). Associations between online pornography consumption and sexual dysfunction in young men: Multivariate analysis based on an international web-based survey. https:\/\/pubmed.ncbi.nlm.nih.gov\/34534092\/"},{"key":"e_1_3_2_6_1","unstructured":"Jiang T. Osadchiy V. Mills J. N. Eleswarapu S. V. (n.d.). Is it all in my head? Self-reported psychogenic erectile dysfunction and depression are common among young men seeking advice on social media. https:\/\/pubmed.ncbi.nlm.nih.gov\/32437776\/"},{"key":"e_1_3_2_7_1","doi-asserted-by":"crossref","unstructured":"Manalo T. A. Biermann H. D. Patil D. H. Mehta A. (2022). The temporal association of depression and anxiety in young men with erectile dysfunction. The Journal of Sexual Medicine 19(2) 201\u2013206. https:\/\/doi.org\/10.1016\/j.jsxm.2021.11.011","DOI":"10.1016\/j.jsxm.2021.11.011"},{"key":"e_1_3_2_8_1","doi-asserted-by":"crossref","unstructured":"Mao Z. Ye J. Pang K. H. Wang C. Zhang Y. (2025). The basis for self-reported sexual dysfunction and the diagnostic value of masturbation-related parameters in men who have not engaged in vaginal intercourse in the past 6 months or have never engaged in it: A comparative study. Sexual Medicine 13(5) Article qfaf087. https:\/\/doi.org\/10.1093\/sexmed\/qfaf087","DOI":"10.1093\/sexmed\/qfaf087"},{"key":"e_1_3_2_9_1","unstructured":"Nguyen V. Dolendo I. Uloko M. Hsieh T.-C. Patel D. (n.d.). Male delayed orgasm and anorgasmia: A practical guide for sexual medicine providers. PubMed. https:\/\/pubmed.ncbi.nlm.nih.gov\/37061617\/"},{"key":"e_1_3_2_10_1","doi-asserted-by":"crossref","unstructured":"Phuah L. A. Teng J. H. J. Goh P. H. (2023). Masturbation among Malaysian young adults: Associated sexual and psychological well-being outcomes. Sexuality & Culture 28 113\u2013133. https:\/\/doi.org\/10.1007\/s12119-023-10101-2","DOI":"10.1007\/s12119-023-10101-2"},{"key":"e_1_3_2_11_1","doi-asserted-by":"crossref","unstructured":"Quang N. Van Truong L. Chung E. (2024). Corrigendum to \u201cpredicting anxiety and depression among erectile dysfunction patients: A cross-sectional study\u201d. American Journal of Men\u2019s Health 18(2) Article 239157. https:\/\/doi.org\/10.1177\/15579883241239157","DOI":"10.1177\/15579883231223502"},{"key":"e_1_3_2_12_1","unstructured":"Quinta-Gomes A. L. Nobre P. J. (n.d.). Erectile disorder. Springer Nature Link (formerly SpringerLink). https:\/\/link.springer.com\/rwe\/10.1007\/978-3-319-59531-3_117-1"},{"key":"e_1_3_2_13_1","doi-asserted-by":"crossref","unstructured":"Rowland D. L. Morrow A. L. Hamilton B. D. Hevesi K. (n.d.). Do Pornography Use and Masturbation Frequency Play a Role in Delayed\/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis| MDPI. Retrieved January 3 2026 from https:\/\/www.mdpi.com\/2411-5118\/3\/1\/10","DOI":"10.3390\/sexes3010010"},{"key":"e_1_3_2_14_1","doi-asserted-by":"crossref","unstructured":"Safa A. Waked C. (2025). Erectile dysfunction in young adults: A narrative review. Cureus 17(8) Article e89918. https:\/\/doi.org\/10.7759\/cureus.89918","DOI":"10.7759\/cureus.89918"},{"key":"e_1_3_2_15_1","doi-asserted-by":"crossref","unstructured":"Stanley E. E. Pfoh E. Lipold L. Martinez K. (2025). Gap in sexual dysfunction management between male and female patients seen in primary care: An observational study. Journal of General Internal Medicine 40(4) 847\u2013853. https:\/\/doi.org\/10.1007\/s11606-024-09004-1","DOI":"10.1007\/s11606-024-09004-1"},{"key":"e_1_3_2_16_1","doi-asserted-by":"crossref","unstructured":"Topak O. Z. Sinik Z. Oguzhanoglu N. K. Ugurlu T. T. (2023). An evaluation of psychogenic predictors of non-organic erectile dysfunction. Medicina 59(7) Article 1195. https:\/\/doi.org\/10.3390\/medicina59071195","DOI":"10.3390\/medicina59071195"},{"key":"e_1_3_2_17_1","doi-asserted-by":"crossref","unstructured":"Tran F. D. Bichai G. H. Kravetz Z. Meriden Z. (2025). Management of antidepressant-induced sexual dysfunction: A literature review. Cureus 17(8) Article e90170. https:\/\/doi.org\/10.7759\/cureus.90170","DOI":"10.7759\/cureus.90170"},{"key":"e_1_3_2_18_1","doi-asserted-by":"crossref","unstructured":"Whelan G. Brown J. (2021). Pornography addiction: An exploration of the association between use perceived addiction erectile dysfunction premature (early) ejaculation and sexual satisfaction in males aged 18\u201344 years. The Journal of Sexual Medicine 18(9) 1582\u20131591. https:\/\/doi.org\/10.1016\/j.jsxm.2021.06.014","DOI":"10.1016\/j.jsxm.2021.06.014"},{"key":"e_1_3_2_19_1","doi-asserted-by":"crossref","unstructured":"Wong L. P. (2012). An exploration of knowledge attitudes and behaviours of young multiethnic Muslim-majority society in Malaysia in relation to reproductive and premarital sexual practices. BMC Public Health 12(1) Article 865. https:\/\/doi.org\/10.1186\/1471-2458-12-865","DOI":"10.1186\/1471-2458-12-865"},{"key":"e_1_3_2_20_1","doi-asserted-by":"crossref","unstructured":"Zhang H. Colonnello E. Zhang H. Sansone A. Xi Y. Wang C. Jannini E. A. Zhang Y. (2023). Erection hardness score in masturbation can serve as a preliminary screening tool for organic erectile dysfunction. Urology 182 149\u2013154. https:\/\/doi.org\/10.1016\/j.urology.2023.08.016","DOI":"10.1016\/j.urology.2023.08.016"}],"container-title":["American Journal of Men's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15579883261441860","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15579883261441860","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15579883261441860","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:28:40Z","timestamp":1777505320000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15579883261441860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1177\/15579883261441860"],"URL":"https:\/\/doi.org\/10.1177\/15579883261441860","relation":{},"ISSN":["1557-9883","1557-9891"],"issn-type":[{"value":"1557-9883","type":"print"},{"value":"1557-9891","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"15579883261441860"}}