Difficulty Getting It Up Could Be One Of The First Signs Of An Underlying Condition

When Zachariah Reitano was 17, he wasn't able to get or maintain an erection. Like most teenage boys, this wasn’t something he’d had trouble with in the past. So when he wasn’t able to get or stay hard, he knew something was wrong. Luckily, Reitano's dad is a sexual health expert and he felt comfortable telling him what was going on. It’s a good thing he did, too, because a stress test on a treadmill at the doctor’s office ended with him getting surgery to repair parts of his heart.

Turns out, Reitano had a previously undiagnosed heart condition and his ED was actually a sign that something really serious was going on. He was lucky to have a parent he felt comfortable turning to about the issue — but most men don’t. In fact, many men who experience ED don't actually get treatment for it, probably because they’re embarrassed. In a culture where men are expected to pop a boner when a potential sex partner even looks at them, admitting that you have ED can be really difficult.

Reitano's experience led him to found Roman, an end-to-end men’s health company. The company uses a responsive chatbot and telemedicine to help people who are dealing with ED get private, confidential treatment. But that’s just the start. “We refer to erectile dysfunction as the ‘check engine light’ for a man,” Reitano tells Bustle. “That’s because it’s often one of the first signs of an underlying condition. ED can sometimes be the first visually recognizable sign for diabetes, heart disease, high cholesterol, high blood pressure, obesity, depression — the leading causes of death in America.”

The first version of Roman focuses mainly on getting men prescription medication to treat their ED. However, Reitano says that their bigger goal is to be an entry point into the health care system for men. And that’s a huge thing — one survey from researchers at Cleveland Clinic that involved more than 500 men between the ages of 18 and 70 found that more than 40 percent of men only go to the doctor when they think there might be a serious problem. That means a lot of men are probably going untreated for a range of illnesses.

Reitano and his team hope that the privacy and accessibility of Roman will help move the dial on that number. They started in California, Pennsylvania, New York, and Florida, because those states have laws allowing telemedicine, and quickly expanded to Georgia, Illinois, Michigan, Montana, Nebraska, Ohio, Texas, Virginia and Washington. If they think a client is a good candidate for ED medication, their doctors will write the prescription, which can be filled at a pharmacy of their choice or in the Roman in-house pharmacy. However, if the doctor thinks there might be a bigger health issue at play, they’ll refund the $15 charge and refer them out to an in-person doctor in their area.

There have been some reports recently that erectile dysfunction is on the rise in young men — and that this is a new phenomenon. Many people think that ED only affects older men, but NIH research shows that about 20 percent of men in their twenties, 30 percent of men in their thirties, and 40 percent of men in their forties experience ED. The causes of ED range from health problems like Reitano’s to psychological problems, to some combination of both.

The mechanics of an erection are actually really complicated, involving arousal centers in the brain and a complicated physical system, so it can be hard to pin down exactly what’s causing ED. However, there’s one potential cause that gets named a lot: Porn. For example, in a recent audio series, journalist and writer Jon Ronson directly linked the rise in ED with the rise in online porn consumption, claiming that there’s been a 1,000 percent rise in ED in young men since 2007. Reitano, however, thinks that might be a little too reductionist.

“There has been an incredible spike in coverage in individuals voicing publicly and privately online in different forums that they’re experiencing porn-induced erectile dysfunction,” Reitano says. “People often want to attribute one cause to an event. But I think the interesting thing about an erection is it requires so many different systems in your body to work in harmony. It’s often not one cause or single event that causes ED, but it’s a factor of multiple systems. It’s definitely important to try to identify the multiple root causes but, again, it’s tough to attribute it to a single thing.”

Whatever the cause, erectile dysfunction can be frustrating, embarrassing, and can take a toll on relationships. If you date and love people with penises, don't freak out if your partner has ED, regardless of their age. Those in Roman's initial launch states, you can check out the app. And if you’re not? Make an appointment with the doctor. I promise you’ve they’ve dealt with this before.