For example, I have seen a high school senior who often displayed destructive behavior and had a criminal record. Erectile dysfunction in a young adult can have a devastating effect on self-image and behavior development. A detailed medical and psycho-sexual history is mandatory to identify the cause and determine management strategy so that unnecessary psychotherapy and suffering can be avoided. Primary impotence can also be caused by psychological factors such as child abuse, rape, religious or moral strictures, or misinformation. There can be several causes: congenital or traumatic artery or nerve injury; congenital or traumatic venous leakage; micropenis; or severe penile deformity. After surgical repair of venous leakage, he became a different person and went back to college. His parents were stunned until the young man confessed that he was depressed because he was unable to attain a normal erection. Another young man quit a famous college during his sophomore year. When I saw him again 5 years later for an unrelated reason, he had a steady girlfriend and was very happy with his sex life. After surgical repair of his venous leakage, his behavior completely changed and he went to a military academy and became an officer. A social worker finally discovered that his self-destructive behavior was a result of his inability to attain a normal erection. Primary impotence is a condition in which a man has never been able to achieve and maintain a normal erection.

He underwent surgery to repair the leakage and within a few days began to experience excellent erections. However, a penile x-ray after dye injection showed large venous leaks at the base of the penis. A penile ultrasound test, given after injection of an erection-producing drug, revealed excellent arterial flow, large venous outflow, and a partial erection similar to his erections at home.