Erectile dysfunction (ED) is the inability to achieve or maintain an erection. Cures for erectile dysfunction can include medication, surgery, lifestyle changes, or managing underlying health conditions.
The Massachusetts Male Aging Study was one of the first studies to report the epidemiology of ED in United States males. Overall, the research found that the condition affects 52% of males aged 40–70 years.
The Boston Area Community Health Survey also states that ED occurs in 10% of males aged 30–39 years, increasing to 59% of males aged 70–79 years.
This article defines what ED is and outlines some of the reasons for its increased prevalence in older men. Finally, we explore some lifestyle tips and medical treatments that could help restore sexual function in older people.
ED is the medical term for when a person has difficulty achieving or maintaining an erection.
Several factors may cause or contribute to ED. Aging is one such reason, as older males are more likely to:
- have medical conditions that can contribute to ED
- take medications that may contribute to ED
- experience decreased testosterone levels, which may reduce sexual arousal
Older males are more likely to have medical conditions contributing to ED. Examples of health conditions include:
These conditions can affect blood flow or nerve sensations, both of which are necessary for an erection. Reduced blood flow, known as vascular insufficiency, is one of the most common causes of ED.
Older males are more likely to take medications to manage underlying medical conditions. While these drugs can enhance overall health, some may worsen ED symptoms. They can include medications for:
- lowering blood pressure, such as:
- heart arrhythmias or other heart problems
- Parkinson’s disease
- reducing pain, such as codeine and morphine
- use in chemotherapy
A person who suspects their medication may be contributing to their ED should discuss this with a doctor. A healthcare professional may lower the dosage or suggest a suitable alternative.
A person should not stop taking a medication unless their doctor has told them it is safe to do so.
Testosterone is a hormone with several important functions within the body. It helps with various aspects of sexual health in males, including:
- regulating sex drive
- maintaining the tissues that supply blood to the penis
A person’s testosterone levels typically decrease as they age. This could lead to a reduction in sex drive, which may contribute to ED. It may also increase scarring in the vein network within the penis, impeding blood flow to that area.
When treating ED, doctors often recommend a combination of lifestyle changes and medications.
The following lifestyle changes may help to treat or prevent ED:
- eating a healthful diet
- engaging in regular physical exercise
- losing weight if a person has overweight or obesity
- stopping smoking
- limiting or avoiding alcohol
- managing any underlying health conditions, such as high blood pressure or diabetes
- improving sleep habits
A lack of sexual desire can also influence ED in older males. According to a 2020 review, an estimated 82.4% of males aged 80 and above report a lack of sexual desire. Seeking treatment from a sex therapist is one option that could improve sexual desire and reduce ED symptoms.
In addition to lifestyle measures, doctors can also prescribe medications for ED. Most are safe for older adults, though a medical professional will need to check they are compatible with other medicines that a person takes.
Below are some medications a doctor may prescribe to treat ED.
One of the most common medical treatments for ED in older people is a class of drugs called phosphodiesterase-5 (PDE 5) inhibitors. These drugs relax and widen the blood vessels, improving blood flow to the penis.
According to a 2017 review, PDE 5 inhibitors are generally safe in older people, including those with cardiovascular diseases. However, they are not suitable for people who take nitrates for heart conditions.
Some examples of PDE 5 inhibitors include:
- avanafil (Stendra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
Testosterone replacement therapy
If an older male has low testosterone levels, a doctor may prescribe testosterone replacement therapy (TRT). This will involve regularly administering testosterone via injections, gel, or a skin patch.
However, TRT will not address some of the more common causes of ED in older adults, such as reduced blood flow or nerve damage.
Alprostadil is an injectable medication or penile suppository that some people may use to achieve an erection. It quickly expands blood vessels in the penis, helping a person gain an erection within 8–10 minutes.
Injectable alprostadil medications include:
- Prostin VR
Alprostadil is one example of intracavernosal injection, but doctors may use a mixture of three drugs called Trimix, which includes alprostadil, phentolamine, and papaverine.
Doctors may also prescribe an injectable suppository known as a medicated urethral system for erection.
Surgery is a possible treatment for males with refractory ED, where other treatments have not been effective.
Penile implant surgery has the highest patient and partner satisfaction of all ED treatments, including oral PDE-5 inhibitors and penile injections.
Older people may experience higher rates of ED compared to those who are younger. They are also more likely to experience medical issues and take medications that increase the likelihood of the condition. An age-related decline in testosterone levels may also contribute to ED.
Anyone who has concerns about ED should see their doctor. A health professional will work to diagnose the cause and provide appropriate treatment.
When treating ED in older people, a doctor may recommend a combination of lifestyle changes and medical treatments. A person can discuss the treatment options with their doctor to determine which approach will be best for them.