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Those Wedding Night Blues

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Impotence expert William Steers, MD, who chairs the department of urology at the University of Virginia Health System in Charlottesville, has another view of honeymoon impotence. He says erectile dysfunction at first sexual encounter is not uncommon in this country, and the cause is usually psychological.

"I work in a university town, and we do see a significant number of students who are seeking medical attention for this problem," Steers tells WebMD. "The vast majority of the time it is due to performance anxiety."

He says depression is a major cause of sexual dysfunction among younger males, but fear of AIDS and other sexually transmitted diseases is also a common culprit. Inexperienced males may also have performance problems if they believe their partner has much more experience.

"I have guys in their 20s walk in the door who are convinced there is something physically wrong with them, even though the tests don't show this," he says. "Nobody wants to hear that the problem is psychogenic, and if you tell them this they will run, not walk, to another physician to find out what is 'really' wrong."

Steers says tests measuring penile blood flow are notorious for producing false positives. For this reason, the findings of Usta and colleagues may exaggerate the physical origin of impotence problems in the young males included in the study.

"The thing is, unless someone has very severe [psychological] problems or a serious medical condition, the range of therapies you offer are pretty similar no matter what the origin of the problem," he says. "But you have to do a reasonable workup to rule out these dangerous problems."

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