Only able to maintain an erection when close to orgasm.

Patient : I'm a 23 year old male, and I'm having trouble keeping an erection lately. I get semi-erect once in a while watching something arousing, but even when stimulating myself or when someone else is doing it, that's as hard as it will stay most of the time. If I get close to orgasm, it gets about fully hard, and I can keep it hard from there if I don't completely stop touching it.. but then it's a fight not to ejaculate, which has never been a problem before. Even ejaculating feels odd, or incomplete, but that could be unrelated. This is embarrassing, so if there's an explanation beyond "it's a psychological issue" that sounds possible, please answer thanks.
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