One of the thing too that we didn’t talk about is injury you get injured in the groinal area things happen guess what you are going to have an issue absolutely absolutely great point one of those things that we worry about especially the younger patient population is something called a saddle injury and so when you have a young man who maybe was riding a bike got into an accident slipped fell and he fell with between his legs that can potentially cause erectile dysfunction as well another injury that one man many men go through is actually treatment for cancers imagine anytime you get treated for cancer that’s an injury to the groin area and that could potentially also cause erectile dysfunction what about impotence and the psychological side of that is well because let’s let’s dive into that if you will this is great I get a lot of younger patients that come to me complaining of erectile dysfunction and this is what we call performance anxiety or psychogenic erectile dysfunction and the concept is very simple this is our body fight-or-flight it’s our body produces two hormones epinephrine and cortisol these are hormones that help us survive a stressful situation well guess what epinephrine and cortisol will help us survive a stressful situation but during that situation the last thing I want to do is be having sex here’s the best way I can describe it when we were cavemen having sex with our partners if a big woolly mammoth came up behind you teacher what would you do you to run right never trying to run with an erection you can’t do it you can’t do it your body prepares yourself for these stressful situations and that essentially is what psychogenic erectile dysfunction is you