Erectile dysfunction, or ED, is a common condition that affects many men as they get older. There are several reasons why men may have difficulty getting or maintaining an erection as they age.
What is Erectile Dysfunction?
Erectile dysfunction (ED) is defined as the inability to get or keep an erection firm enough for sexual intercourse. It can occur at any age but becomes more common with increasing age. Some statistics on ED include:
- Around 30 million men in the US suffer from ED
- The risk of ED increases with age – about 4% of men in their 50s have complete ED, rising to nearly 17% of men in their 60s and 70% of men older than 70
- ED affects work productivity and quality of life
While ED becomes more prevalent with age, it is not an inevitable part of aging. Understanding the causes can help men identify ways to prevent or treat ED.
What Causes ED as Men Age?
There are several factors that contribute to ED as men get older:
Decreased Blood Flow
Erections occur when blood flows into the penis and gets trapped there, causing the penis to expand and stiffen. With aging, blood vessels can narrow and lose flexibility, reducing blood flow to the penis. Diseases that affect the blood vessels, such as atherosclerosis, can also contribute to ED.
Hormone Changes
Testosterone is the key hormone involved in sexual arousal and desire in men. Testosterone levels peak in most men during their late teens to early 20s, after which they slowly decline, typically at a rate of around 1% per year after age 30. Lower testosterone reduces sexual desire and can lead to ED.
Nerve Damage
The nerves involved in erections can become damaged over time due to conditions such as diabetes, prostate surgery, and neurological disease. Nerve damage disrupts signals between the brain and penis, preventing erections.
Certain Medications
Many common medications can negatively impact erections, including drugs for high blood pressure, depression, anxiety, pain, and prostate problems. The mechanisms vary – some reduce blood flow or testosterone, while others interfere with nerve signals.
Psychological Factors
Stress, anxiety, depression, worry about sexual performance, and relationship issues can all impact arousal, desire, and erections. While these psychological factors can affect men of any age, they may play a larger role in ED as men age.
Unhealthy Lifestyle Habits
Obesity, smoking, excessive alcohol use, and lack of physical activity all raise the risk of ED. Adopting healthy lifestyle habits can help prevent or manage ED.
How Aging Affects Erections and ED
Here is a more in-depth look at some of the key age-related changes that contribute to ED:
Declining Testosterone
Testosterone directly impacts sexual interest, arousal, erections, ejaculation, and orgasm. As testosterone declines with age, many men notice:
- Reduced sexual thoughts/fantasies
- Less frequent erections, such as during sleep
- Difficulty getting an erection
- Erections are not as firm as they used to be
- More time needed between erections
- Less forceful ejaculation
Testosterone replacement therapy can help some men, under the supervision of a doctor. However, it may not benefit all men with low testosterone and has some risks if not monitored properly.
Blood Vessel Changes
Aging causes changes in blood vessels, including:
- Hardening and narrowing of arteries (atherosclerosis)
- Reduced production of nitric oxide, which relaxes blood vessels
- Endothelial dysfunction – inability of blood vessels to dilate properly
- Damage to blood vessels due to diseases like diabetes
These vascular changes reduce blood flow into the penis, making it difficult to sustain an erection. They also affect overall cardiovascular health. Managing heart disease risk factors like high blood pressure helps minimize vascular ED.
Nerve Damage
The nerves that coordinate erections can become damaged over time. Contributing factors include:
- Chronic illnesses such as diabetes, multiple sclerosis, kidney disease
- Nerve dysfunction after prostate surgery for cancer
- Trauma or injury to pelvic area or spinal cord
- Neurological diseases like Alzheimer’s and Parkinson’s
- Certain medications for depression, anxiety, pain
Nerve signals between the brain and penis can get disrupted, preventing erections. If the cause is reversible, like medication side effects, it may be possible to restore normal nerve function.
Reduced Muscle Tissue
Starting around age 30, lean muscle mass begins declining. Loss of muscle tissue accelerates after age 60. The tissues in the penis also break down with aging:
- Corpora cavernosa – two chambers that fill with blood during erections shrink
- Less smooth muscle tissue in corpora – produces nitric oxide to assist erections
- Tunica albuginea – membrane enclosing the corpora thickens and loses elasticity
This structural change in the penis contributes to weaker erections as men age. Strength training exercises can help maintain muscle mass.
Medical Conditions
Several age-related diseases increase the risk of ED, including:
- Atherosclerosis – hardening of arteries
- Heart disease
- High blood pressure
- High cholesterol
- Obesity
- Diabetes – impairs blood flow and nerve function
- Parkinson’s disease – impairs central nervous system
- Multiple sclerosis – damages central nervous system
Lifestyle changes, medications, or treating the underlying condition may improve ED related to medical conditions.
Prevalence of ED by Age
Here is an overview of how common ED is at different ages:
| Age Range | Prevalence of Moderate to Complete ED |
|---|---|
| 40-49 years | 6% |
| 50-59 years | 20% |
| 60-69 years | 30% |
| 70 years and older | 70% |
While ED increases significantly with age, it is not an inevitable part of aging. Maintaining health and wellness habits can help prevent or delay ED.
When to Seek Medical Advice
Men experiencing persistent ED should talk to their doctor, who can assess for underlying causes and provide appropriate treatment. Seek medical attention for ED if:
- You regularly have difficulty getting or maintaining erections
- Erections are not firm or long-lasting enough for intercourse
- ED symptoms are affecting your relationship and quality of life
- Erections have gotten progressively worse over time
- ED occurs with other sexual problems like premature ejaculation
- You have a chronic health condition that puts you at risk for ED
Do not assume ED is an inevitable result of aging. Document your symptoms and talk to your doctor to identify factors you can modify to improve sexual health and performance.
ED Evaluation and Diagnosis
A physician will start by reviewing your medical history and performing a physical exam. They may order additional tests to pinpoint the cause, including:
- Blood tests – check testosterone, cholesterol, blood sugar, liver and kidney function
- Urinalysis – screens for signs of diabetes, bladder issues, or infection
- Ultrasound – evaluates blood flow into the penis
- Overnight erection test – monitors erections during sleep to detect physical vs psychological causes
- Psychosocial evaluation – explores relationship, stress, depression factors
- Cardiovascular assessment – heart disease significantly increases ED risk
Once the cause is determined, the doctor will recommend appropriate treatment options.
Treatments for Age-Related ED
Depending on the severity of ED and underlying cause, treatment options may include:
Lifestyle Changes
- Quitting smoking, alcohol use, and substance abuse
- Exercising regularly to maintain cardiovascular and sexual health
- Losing weight
- Reducing stress
- Prioritizing sleep quality
Medications
- PDE5 inhibitors like Viagra, Cialis, Levitra – improve blood flow to the penis
- Testosterone replacement therapy – treats low testosterone
- Alprostadil injections into the penis
Devices
- Vacuum erection devices – use suction to draw blood into the penis
- Penile implants – surgically inserted devices that allow men to mechanically control an erection
Counseling
- Sex therapy
- Couples counseling
- Psychotherapy
A combination of treatments tailored to the individual often works best. Open communication with your partner is also key to improving sexual intimacy.
Outlook
While ED becomes more common with age, it is treatable at any age. Safe and effective solutions are available. Being proactive about screening for ED risk factors, adhering to medical treatment, and communicating concerns early on can help men minimize the impact on sexual health and relationships.