Old man hard on

PMC

Discussion

This cross-sectional, observational, population-based field survey reported the prevalence of ED in Turkish men aged ≥40 years as 33% (25.6% mild, 5.5% moderate, and 1.9% severe ED) by using validated, multi-item questionnaires. Based on these data, it can be calculated that among all ED men aged ≥40 years, the rate of moderate-to-severe ED was 22.5%. The overall rate for moderate-to-severe ED in the entire population was calculated as 7.4 percent. This work has also confirmed that the prevalence and severity of ED was significantly correlated with age as reported by previous studies worldwide. Last but not the least, our data suggested that, apart from age, vascular risk factors and prostate disorders were the independent predictors of ED.

Previously, Turkish Erectile Dysfunction Study Group carried out a study in 1999 and published in 2003 that age-adjusted overall prevalence of ED in Turkish men ≥40 years of age were 69.2% (including mild, moderate and severe ED) by using single-item question. Erectile functions of all the participants in that study were assessed with single question that also used in the Pfizer Cross-national Study of Erectile Dysfunction as “How would you describe yourself?” and the categorical responses were considered as “no ED,” “mild (minimal) ED,” “moderate ED,” and “severe ED”. Cross-national study of the prevalence and correlates of ED conducted between 1997–1998 and reported in 2003 by Nicolosi et al utilized the same single-item question in order to assess the presence and severity of ED in men aged between 40–70 from 4 countries and reported the age-standardized prevalence of ED as between 42% and 78% in Brazil, Japan, Italy, and Malaysia.

A systematic review conducted on prevalence of ED in general population evaluated 23 published studies from all over the world based on 12-item criteria and reported that only a few of them have fulfilled the criteria of required methodological quality. Abovementioned two studies that used the same single-item question reported the prevalence of ED which led to an overestimation relative to others as their evaluation of ED was based on one question. Our current study has taken all of the mistakes made by previous works into consideration, and used all methodological criteria defined by Prins et al. Our study also included all external and internal validity and informativity checklists and found the actual prevalence of ED as 33% in Turkish men ≥40 years of age by using nationally-validated and universally-accepted IIEF questionnaires.

ED has been considered as age-dependent phenomenon due to increased rates of comorbidities and enhanced severity. Previous well-conducted epidemiological surveys have also focused on age-dependency of ED. Two of the Asian studies showed doubling of the prevalence rate at age 60–70 with almost another doubling at age 70–79 years. The more recent Korean report stratified by age showed a tripling of the prevalence for the 60–69 age group compared to those younger whether self-reported or scored by the IIEF. Another recent report from western Australia had an older age range in their study and reported an overall prevalence rate of 40.3%, almost 4 times the prevalence from the other age-stratified study with an overall ED rate of 10 percent. Our study found similar results regarding age-dependency of ED by showing the higher rates of ED in 60–69 (68.8%) and ≥70 (82.9%) compared to those in 40–49 (17%) and 50–59 (35.5%) years of age. When compared to the age of 40s, the relative risk was increased 3-fold in 50s, 7.5-folds in 60s and 15.5 fold in 70s and older.

Depending on the underlying vascular risk factors as well as age, an increased severity of ED can be expected. The widely-cited MMAS study showed that 52% of men aged 40–70 years had some degree of ED. Moderate-to-complete ED was encountered in 34.8% of men, which was strongly related to age and associated with a number of major medical conditions. This rate for ED was confirmed by Rosen et al. data derived from the multinational MSAM-7 survey that reported 48.7% of men had erection difficulty and 10% of men had complete absence of erection based on responses to DAN-PSS questionnaire. Our study reported prevalence of ED as 33% in men aged ≥40 years, of those 25.6% had mild, 5.5% moderate, and 1.9% severe ED. Among all men with ED aged ≥40 years, the rate of moderate-to-severe ED was found to be 22.5% in our study. The overall rate for moderate-to-severe ED in entire population was calculated as 7.4%. When the rate of having moderate-to-severe ED in all study participants was stratified and calculated based on the age groups, there was a significant change according to the each decade of aging as 2.5% for 40–49, 5.8% for 50–59, 12.9% for 60–69, and 49.2% for ≥70 years, demonstrating age-dependency for the severity of ED.

The main cause of ED is organic in nature, with vascular etiologies being the most common risk factors. The incidence of ED increases with the number of vascular comorbidities such as hypertension, diabetes mellitus, ischemic heath disease, dyslipidemia, and atherosclerosis. The earliest signal of endothelial damage in men with vascular risk factors is the manifestation of ED. As the penis is a barometer of the body’s endothelial function, it is reasonable then to blame vascular pathologies, as direct causes of ED. ED may be the first clinical presentation of any of these comorbidities with the vascular endothelium playing a pivotal role in regulating vascular homeostasis of the corpora cavernosa. Previous works demonstrated that the presence and number of associated vascular risk factors were correlated with the severity of penile vascular abnormalities evidenced by penile Doppler duplex ultrasound evaluation. In our current work, we also assessed the impact of co-morbidities on the presence and severity of ED.

According to the multimodal regression analyses, we found significantly higher rates of moderate-severe ED in men with comorbid vascular risk factors compared to men with no-ED or mild-ED. The RR for having moderate-severe ED compared to no-ED and mild-ED was found 5-fold in diabetes, 4.4-fold in hypertension, 3.4-fold in atherosclerosis, 2.6-fold in coronary artery disease, and 2.1-fold in dyslipidemia. Considering its multifactorial deleterious affect on penile erection, diabetes has been considered as the strongest underlying risk factor for ED. In our study population, 9.2% of the subjects with no ED-mild ED reported diabetes in contrast to 33.6% of the cases with moderate-severe ED. Not only the higher prevalence of ED in diabetic subjects, but also the severity of ED was significantly higher in diabetic men. Another important comorbidity, high blood pressure was seen 19.1% of no ED-mild ED cases, but the rate was 51% in moderate-severe ED cases, demonstrating the strong relationship between severity of ED and hypertension. Other vascular risk factors including dyslipidemia, atherosclerosis and coronary artery disease were significantly correlated with the prevalence and severity of ED in men agyed ≥40 years.

Epidemiological surveys using internationally-validated symptom scales, such as IPSS, have reported an overall rate of LUTS as >50% in men >50 years of age. The MSAM-7 study by including a total of 14,000 male aged 50–80 years has reported prevalence of moderate-severe LUTS as 31% (34.2% for Europe and 29% for the US). Due to common pathophysiological links, LUTS suggestive of BPH and ED have been shown to have strong relationships evidenced by epidemiological surveys. The current study reported that three out of four men aged ≥40 years exhibited some degree of LUTS, of which only 16.3% was moderate-to-severe. When this association was evaluated, our study has been presenting further statistically meaningful support to the link between ED and prostatic diseases including chronic prostatitis and BPH. Based on the regression analyses of the study population, it can be postulated that chronic prostatitis had 2.4-fold and BPH had 3.5-fold increased risk of having moderate-severe ED in men ≥40 years of age.

Sexual activity is considered as an integral part of men’s health and their quality of life. As a part of ageing and deterioration of sexual functions, the number and quality of erection can be expected to reduce. Mean monthly sexual activity was also assessed in this study and found to be 8.4 in men without ED. Compared to the men with no ED or mild ED, mean monthly sexual activity was found to be significantly reduced in men with moderate (3.7) and severe (2.9) ED. These data would further support practicing physicians to focus on treating males’ sexual dysfunctions in order improve their overall health and quality of life.

The limitation of this study was the age of the study population. In order to reflect to the criteria for a population-based survey, relatively younger men had to be included into the study for representing the nations’ age, as seen in the 40–49 year-old group that consisted of 40% of the participants. Due to this age distribution, the prevalence of ED found in this population-based survey might be different from previously published international large-population surveys including the MSAM-7 and MMAS outcomes. We believe that this age distribution needs to be taken into account when evaluating outcomes of this survey.

In conclusion, this population-based survey in Turkish men of ≥40 years of age reported the prevalence of ED as 33 percent. Furthermore, this study reported age as the main predictor for presence and severity of ED. As parallel to the previous epidemiological reports, this work have provided further support to the contribution of vascular risk factors and a number of lifestyle issues on ED. We believe that a greater understanding on the epidemiological surveys of the prevalence of ED and its associations will help clinicians to look outside our specialty for strategies to improve male sexual function in order to improve their quality of life. It is crucial to take a more global approach to management of ED, one that focuses not only on chronic diseases, but also men’s sexual quality of life.

Erectile dysfunction, commonly referred to as ED, is defined as the inability to attain or maintain an erection needed for sexual performance. It affects over 12 million men in the United States alone. Although erectile dysfunction can affect men of any age once they pass puberty, it is most common in men over 40 years old and its likelihood increases with older age.

The most frequent question men have when they experience any form of ED is “Why is this happening to me?”. While your doctor or healthcare provider would be the one to tell you the reason it is happening to you, here are the top 10 causes or risks for ED in general.

1) Age

Just like with many health issues, erectile dysfunction becomes more common or worse as you age. While about 2% to 12% of men at age 40 experience some form of ED, this percentage goes up with every decade of life. In fact, more than half of men over 70 years old experience some symptoms of ED.

2) Sedentary lifestyle

I know. You probably already know that being overweight is bad for your health. But, did you know that being overweight actually causes your body to turn testosterone into estrogen? This is one of the reasons scientists believe obesity and a sedentary lifestyle (little to no exercise, unhealthy food choices, etc.) lead to problems with erectile dysfunction.

The good news is this is a reversible problem. As you lose weight or exercise more, you might notice your erections getting better and lasting longer. Always check with your healthcare provider before starting any diet or exercise plan, though.

3) Diabetes

Diabetes is such an overwhelming health problem for many reasons, and unfortunately, erectile dysfunction is one of the many problems a man with diabetes may have to deal with in his life. The longer you have diabetes (either Type 1 or Type 2), the more likely you are to experience ED.

But, more importantly, how well you control your blood sugar levels really affects your risk for ED. An estimated 2% to 12% of all 40 year old men experience ED, but that percentage jumps to 50% if you only look at those with high blood sugar. Erectile dysfunction caused by diabetes isn’t always a completely reversible problem, but you can definitely make it a lot better or less likely to happen by following your doctor’s advice to control your blood sugar.

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4) Heart disease and high cholesterol

Erectile dysfunction actually has an interesting relationship with a man’s heart health. It’s been known for a while that things like high blood pressure and high cholesterol can cause ED; however, recent research has actually shown that when healthy men develop erectile dysfunction, many of them end up being diagnosed with heart disease less than 5 years later. So, if you are experiencing ED and have had no other health issues, you may want your doctor to take a look at your heart. You might be able to prevent the development of heart disease.

5) Smoking

Smoking and other tobacco use is connected to many health problems, including erectile dysfunction. The use of tobacco decreases blood flow throughout your entire body. This includes the blood vessels in a man’s penis. If the blood supply is decreased there, it becomes much more difficult for you to achieve and maintain an erection. Thankfully, this is reversible. If you stop smoking, you’ll notice your erections will improve.

6) Medication side effects

There are a number of medications, both prescription and otherwise, that can contribute to or cause erectile dysfunction. Some of these include antidepressants, blood pressure medications, antihistamines, acid reflux medications, and opioid pain medications. There are many other medicines that can also lead to ED, so if you are having difficulty with erections and recently started a new medication, ask your pharmacist or the doctor who prescribed you the medicine if they could be connected. On a separate but related note, overuse of alcohol and recreational drugs (including marijuana), can also lead to symptoms of ED.

7) Mental health issues and performance anxiety

You have probably heard the phrase “mind over matter” before. Well, when it comes to erectile dysfunction, your brain plays a major role in your ability to achieve and sustain an erection. If you’re under mental stress or having mental health issues, your brain can have trouble creating the nerve connections and releasing the hormones responsible for causing an erection. Examples of these stressors or issues include things like depression, anxiety, overconsumption of pornography, and even nervousness in the bedroom (think first-time jitters). These are manageable and potentially reversible with the right support or treatment.

8) Prostate inflammation and prostate cancer

It should be no surprise that an unhealthy prostate can lead to erectile dysfunction. The prostate is responsible for creating one of the components of semen. While benign prostatic hyperplasia (BPH) doesn’t cause ED, the medicines used to treat it can. On the other hand, chronic inflammation of the prostate or prostate cancer can cause painful ejaculation and difficulty achieving an erection. Be sure to talk to your doctor if you have known prostate issues and are experiencing ED.

9) Sexually transmitted infections (STIs)

A common question men have is whether sexually transmitted infections (formerly known as STDs) can lead to erectile dysfunction. The short answer is yes. Certain STIs, like chlamydia, gonorrhea, untreated HIV, and viral hepatitis can sometimes cause infections in the prostate gland. If this does happen, then it is possible for you to have symptoms of ED.

Most of the time, if you treat both the prostate infection and take steps to manage STIs, any issues with ED will resolve as well. If a prostate infection is left untreated, though, it can cause permanent damage, so it’s better to see your doctor about it sooner rather than later.

10) Low testosterone (low T)

An estimated 1 in 4 men has lower-than-normal levels of testosterone. Low T causes all types of men’s health issues, including hair loss, insomnia, low sex drive, and erectile dysfunction. The lower the level of testosterone, the more symptoms you may experience.

This is very easy to identify with a simple blood test, and can be managed with medications. Once testosterone levels are brought back to normal, most men will notice their ED symptoms getting better or going away altogether.

– – –

While erectile dysfunction might seem overwhelming or like another stressor to add to the pile, just know that there are several treatment options out there. The hardest part for most is starting the conversation with their doctor. But, by working with your healthcare provider, you can find a regimen that works for you and helps give you that piece of your life back again. There’s an answer out there for just about everyone.

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  • The Younger the Man, the Better the Function

    Results showed that age played a primary role in men who said they had ED. The older the men, the higher the reports of ED. The reports ranged from “good” function among younger men to a steady decline to “poor” among the older group.

    The majority of younger men (74%) rated sexual function as good or very good; only 10% of men older than 80 rated sexual function the same. Only 12% of younger men reported big or moderate problems. But nearly a quarter to a third of men older than 50 reported this degree of severity in sexual function.

    • 2% reported first experiencing ED before age 40
    • 4% reported first experiencing ED between ages 40 to 49
    • 26% reported first experiencing ED between ages 50 to 59
    • 40% reported first experiencing ED between ages 60 to 69

    Men with a healthy lifestyle and no chronic disease had the lowest risk for erectile dysfunction; the greatest difference was seen for men aged 65-79. For instance, men who exercised at least three hours per week had a 30% lower risk for ED than those who exercised little. Obesity, smoking, and excessive TV watching were also associated with having a greater risk of erectile dysfunction.

    Erectile dysfunction affects as many as 20 million American men. It can be devastating to self-esteem and have far reaching effects on relationships. Researchers say they hope their study will shed new light on the condition and help fight its social stigma.

    Urology

    Erectile Dysfunction (ED)

    The UW Health Men’s Health program offers comprehensive and compassionate expertise for a wide array of men’s urological needs, including erectile dysfunction, hypogonadism (low testosterone) and urinary problems.

    Dr. Dan Williams on Erectile Dysfunction

    Definition of Erectile Dysfunction

    Erectile dysfunction can encompass several different conditions of reproductive health and sexual dysfunction. It is a very common condition, but is also a very emotional and sensitive topic to discuss. Erectile dysfunction is defined as the inability to maintain an erection sufficient for sexual intercourse.

    Achieving an erection is a complex process involving the brain, hormones, nerves, muscles and blood circulation. If something interferes with this process, the result may be erectile dysfunction. In some cases, erectile dysfunction is the first sign of other serious underlying health conditions, such as cardiovascular problems, that need treatment because erectile dysfunction can share the same risk factors for heart attacks and strokes.

    How common is Erectile Dysfunction?

    About 5 percent of men that are 40 years old have complete erectile dysfunction, and that number increases to about 15 percent of men at age 70. Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s). Erectile dysfunction can occur at any age, but it is more common in men that are older. Older men are more likely to have health conditions that require medication, which can interfere with erectile function. Additionally, as men age, they may need more stimulation to get an erection and more time between erections.

    Three Components of Male Sexual Function

    There are three essential components of male sexual function:

    • Interest and desire for sexual activity (libido)
    • The ability to obtain and maintain an erection
    • Ejaculation and climax (orgasm)

    During an initial visit, the urologist will help to differentiate which components of the male sexual function are affected. This is an important step because treatment options for differ depending on the affected components.

    Causes of Erectile Dysfunction

    There are many possible causes of erectile dysfunction, both physical and psychological, including:

    Psychological/Environmental

    Physical/Organic

    • Poor communication with partner
    • Alcoholism
    • Stress
    • Anxiety
    • Depression
    • Fatigue
    • Smoking
    • Drug abuse
    • Injury to the penis
    • Prostate cancer treatment
    • Spinal cord injury
    • Neurological diseases
    • Heart disease
    • Peyronie’s disease
    • Kidney disease
    • Atherosclerosis
    • Diabetes
    • Obesity
    • Low testosterone
    • High cholesterol and lipid levels
    • Hypertension (high blood pressure)
    • Hormonal disorders
    • Certain medications
    • Lower urinary tract symptoms due to benign prostatic hyperplasia

    Preventing Erectile Dysfunction

    There are several steps men can take to reduce their risk for erectile dysfunction, including:

    • Quit smoking
    • Exercise regularly
    • Maintain a healthy weight and healthy diet
    • Limit or avoid the use of alcohol
    • Reduce stress
    • Get help for anxiety or depression
    • Discontinue drugs with harmful side effects
    • Have regular check-ups with a primary care physician to monitor blood pressure, blood sugar and cholesterol levels

    Treating Erectile Dysfunction

    UW Health urologists with advanced training offer medical and surgical treatment options for men and their partners affected by erectile dysfunction. There are several different ways that erectile dysfunction can be treated. For some men, making a few healthy lifestyle changes may solve the problem. Your urologist will help determine the most effective course of treatment for your condition.
    Treatment options for ED include:

    • Medications (including oral and injectable)
    • Hormone replacement therapy
    • Vacuum erection devices
    • Penile implants

    Dr. Dan Williams on Erectile Dysfunction Treatments

    Internet Resources

    Midwest Center for Psychotherapy and Sex Therapy

    Treating Erectile Dysfunction

    Myth: Pills are the only way to treat erectile dysfunction.

    Fact: There are many options to treat ED. Medicine that the FDA has approved for ED work well for many men. These include medications taken by mouth, injected into the penis, or put into the urethra — the tube that goes through the penis and carries urine and semen.

    If your ED is caused by another health problem, like high blood pressure, you can help your erection problems if you treat that condition. If you have ED because it’s a side effect of a medicine you take, your doctor may be able to switch you to another medication. Don’t stop taking any medication before talking to your doctor.

    You may also be able to make a few lifestyle changes. For example, it may help if you quit smoking, lose weight, or cut down on how much alcohol you drink.

    Psychotherapy has also been useful for a lot of guys who get ED because of anxiety. You can find a trained counselor with experience in this treatment by contacting the American Association of Sexuality Educators, Counselors and Therapists.

    Mechanical vacuum devices and surgical treatments may also help with erection problems.

    Myth: I can treat ED myself without seeing a doctor by using herbal remedies and supplements.

    Fact: You run several risks when you take supplements for ED. For one thing, you may not be able to tell the exact contents of many of the supplements sold as ED treatments. It’s possible they could have dangerous ingredients that might not mix well with other medications you take.

    Also, if you take supplements without talking to your doctor, it means you’re not getting checked for conditions like diabetes and heart disease that may be causing your ED.

    Only a relatively small number of men have ED because of insufficient levels of sex hormones. However, for those who do, the problem is relatively easy to solve with hormone replacement medicines. Hormone replacement is not without its side effects. Please discuss possible side effects with your doctor.

    • Suppositories. This treatment involves using an applicator to insert a tiny suppository into the tip of the penis to widen the penile blood vessels. Tests suggest this method can be more painful and less effective than injection therapy.
    • Injection therapy. This therapy involves self-injection directly into the base or side of the penis to dilate blood vessels to produce an erection. The procedure is relatively painless, but possible potential side effects include bleeding from the injection, a burning sensation in the penis, dizziness, heart palpitations, flushing, scarring or fibrous tissue forming at the injection site, and prolonged erection.
    • Surgery. There are several kinds of prosthetic devices that can be implanted in the penis. The two main types are (1) inflatable silicone or plastic tubes and (2) semi-rigid rods (made of metal covered by silicone or polyurethane). Implanting these devices is a surgical procedure requiring anesthesia and possibly an overnight in the hospital, with all the possible side effects of any surgery. This step is irreversible. For men whose ED is caused by blocked blood supply to the penis because of injury to the penis, pelvic area, or other vascular problems, vascular surgery of the penis may be the solution. These surgeries are not common and they’re recommended only for men with very specific conditions.
    • Psychotherapy. Individuals with ED caused by psychological issues will generally be referred to a mental health professional specializing in sex therapy. Issues can include:

    * Lack of sexual knowledge
    * Lack of communication between partners
    * A poor relationship between partners
    * Performance anxiety
    * Depression
    * Life stresses
    * Inhibition related to upbringing, religion, and social background

    This article reprinted with permission from Second Opinion, a public television health program hosted by Dr. Peter Salgo and produced by WXXI (Rochester, NY), West 175 and the University of Rochester Medical Center.

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    Sexual dysfunction vs. erectile dysfunction

    Getting an erection is a complex process where physiological and psychological processes act together to make the penis erect. Erectile dysfunction is defined as regular difficulty getting or maintaining an erection for satisfying sex. The term “sexual dysfunction” as it relates to men is more broad than that. Sexual dysfunction encompasses many issues that affect successful intercourse, one of which is erectile dysfunction, but it also refers to a man’s overall desire to have sex and the general quality of his erections.

    Researchers have studied erectile dysfunction and sexual dysfunction in great detail, including what causes these conditions, how common they are, and how they can be treated. In one such study, researchers surveyed 31,742 male health professionals from the U.S. ages 53 to 90 to understand how age and other factors affect rates of erectile dysfunction in the male population. (Men with prostate cancer were not included in the study.) And results from those surveys were published in 2003 in the Annals of Internal Medicine, a clinical research publication for healthcare providers, which we’ll discuss below.

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    At what age does ED start?

    There is no specific age at which the penis stops working and erections no longer happen. And even though erectile dysfunction is common, not every man will experience this issue.

    On the other hand, the percentages flip when you look at statistics for younger men. In the study, the vast majority of respondents (74%) 53 to 59 years old rated their ability to function sexually as “good” (30%) or “very good” (44%).

    So, it would appear that somewhere between the ages of 60 and 80 years old, the inability to function sexually becomes much more common.

    In addition to these findings, the study also looked at how the desire to have sex changes as men age. The group of men between the ages of 53 and 59 generally felt that their desire to have sex was good. 70% of these men said their desire was either “very good” (34%) or “good” (36%), while only 25% of men 80 to 90 years old said their desire was either “good” (20%) or “very good” (6%).

    In other words, a man’s ability to function sexually tends to decline as he ages, but so does his desire to have sex in the first place. Whether one is a cause or effect of the other is to be determined. There are also likely to be many other factors in play here, but still, it’s an interesting overlap.

    – – –

    Though it is impossible to say definitively at what age a man will experience erectile dysfunction (or if he will experience it at all), the study above gives us some insight into when ED might become more common in the general population. According to the study, “After age 50 years, the percentage of men who had experienced their first problems with erections increased sharply—26% in men age 50 to 59 years and 40% in men age 60 to 69 years.” Additionally, healthy men who had no other risk factors for ED (chronic diseases or medications known to cause ED) were more likely to get ED between the ages of 65 to 79 years of age compared to any other time in their life before then.

    Causes of impotence in middle-aged men

    Many things can increase a man’s chances of experiencing erectile dysfunction, regardless of age. These include health conditions like diabetes, heart disease, and high cholesterol. But it can also be related to lifestyle habits like not exercising regularly. In particular, being overweight can significantly impact your risk for ED. Drinking alcohol and smoking are both related to ED as well. In the study above, those who drank in moderation and did not smoke were less likely to have erectile dysfunction compared to those who drank alcohol in excess and smoked regularly. Lastly, various medications can increase the likelihood of having ED, such as certain antidepressants, opioid pain medications, and even some blood pressure drugs.

    Keep in mind

    While there isn’t an exact age at which erectile dysfunction starts, one thing that research has established is that no matter your age, there are simple things you can do to help improve sexual function and prevent ED.

    For instance, in the study above, male medical professionals who exercised more were less likely to have ED. Specifically, frequent vigorous exercise (defined as “the equivalent of running at least 3 hours per week or playing singles tennis 5 hours per week”) was associated with about a one-third lower risk for ED compared to men who exercised less than 2.7 hours a week. In fact, a recent research study published in the Journal of Sexual Medicine found that weekly cardiovascular exercise improved sexual function in both men and women.

    For more tips on how to treat and prevent ED, see our guide on treatments here, and don’t forget to ask your doctor for recommendations that are tailored to your age and health circumstances.

    Sources

    More information and resources

    • American Academy of Family Physicians
    • American Urological Association Foundation
    • National Institutes of Health

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    • Like everything in nature, your penis goes through a series of changes over your lifetime. Each phase is controlled mostly by your testosterone levels.

      Somewhere between the ages of 9 and 15, your pituitary gland releases hormones that tell your body to start making testosterone. Puberty begins and brings changes. Your testes (testicles), scrotum, penis, and pubic hair all begin to grow. Testosterone levels peak in your late teens to early 20s.

      The amount of testosterone in your body may drop slightly in your late 20s through your 40s, but the change is minimal.

      After 40, your total levels may drop only a small amount. But your body slowly begins to make more of a protein called sex hormone binding globulin (SHBG). This sticks to the testosterone in your blood and lowers the amount your body has available to use.

      As testosterone levels fall, you’ll notice other changes, to your:

      Pubic hair: Like the hair on the rest of your body, it will thin and may turn gray.

      Penis size: You may notice that it doesn’t seem as large as it used to. The actual size probably hasn’t changed at all. But if you have more fat on the pubic bone just above your penis, that area can sag and make it look smaller.

      Penis shape: For a small number of men, it may curve with age. This can affect its length, girth, and function. The condition, called Peyronie’s disease, is caused by physical trauma — usually because the shaft gets bent during sex. As it heals, scar tissue forms along the tunica albuginea — a tough sheath around the spongy tissue that fills with blood to create an erection. The scarred portion can’t expand, causing a curved erection. The condition can often be corrected surgically or treated with medications.

      Testicles: The small organs inside your scrotum mostly exist to make sperm. As your testosterone levels fall, sperm production slows and they shrink.

      If you get hormone replacement therapy, your pituitary gland will stop sending signals to your testes to make testosterone, and they will shrink more.

      Dr David Lee, a research fellow at Manchester University’s School of Social Sciences, calls them “sexual survivors” – people over the age of 80 who still enjoy an active sex life. In a report written with Professor Josie Tetley, using data from the English Longitudinal Study of Ageing, he notes that while physical challenges (erectile difficulties, for instance) occured more frequently with age, the emotional side of sex appeared more fulfilling for people over 80. Men and women in this age bracket reported more shared sexual compatibility and emotional closeness than those in their 50s, 60s and 70s – which sounds like good news for anyone going through a drought in middle age.

      Sex isn’t defined by penetration, says Lee – some older people find more imaginative ways to keep their sex lives active. “We saw quite a lot of adaptation in the older people, saying they no longer had penetrative sexual intercourse and were more content with kissing and cuddling and general intimacy. We kept a very broad definition of sex. We saw what appeared to be adaptive behaviour in the older members of our sample.”

      Don’t bank on hitting your sexual peak so late, though. The problem is, having a sex life at all in your 80s is far from guaranteed. Only about one in 10 women aged 85 or older, and nearly one-quarter of men of that age, enjoy one. “They’re a minority, clearly, but they’re an interesting minority,” says Lee. “Among those who were , it was quite interesting that they seemed happy with their sexual lives.”

      Lee is studying what it takes to become a sexual survivor. There is likely to be a range of factors, he says. Having a partner is important, of course, and many people in their 80s have been widowed. “I would envisage that these are the healthiest people in older age,” he adds. Medication, for instance, can interfere with sex drive and ability.

      Sexually active octogenarians are still considered such a curiosity that documentaries are made about them (such as Channel 5’s Party Pensioners, which featured an octogenarian burlesque dancer, and Sex and the Silver Gays, a film about older gay men who go to sex parties). Sites aimed at millennials run interviews with them, too – in 2015, Vice published an interview with an 82-year-old called Chris Wilson about his exploits on Grindr (he said he found the hook-up app “especially helpful when travelling. When I was in London, England, I got hit on by about 40 guys. I had sex eight times in seven days!”).

      Lee says we need to get used to the idea that some older people may want a fulfilling sex life – and take seriously the means to allow them to achieve this. “We’re simply trying to broaden the discussion around sex and saying, irrespective of age, there is a need for joined-up healthcare services that people can access if they wish. We’re seeing from the comments in our survey when older people try to access healthcare sexual problems they have come across dismissal: ‘You should expect it at your age.’” But Lee has also seen how it becomes internalised in older people: “They think: ‘It’s not relevant to me any more.’” Better, instead, to know you could enjoy a later-life sexual peak.

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