Is ED a normal process of aging? Is ED preventable? Is it curable?

Older men often note that it takes longer to achieve an erection. In fact, men older than 50 years can take 2 to 3 times longer to develop an erection than younger men. The erection may not be as rigid as in younger years, and arousal alone may not lead to full rigidity without tactile (touch) stimulation. It may also take longer to climax. Ejaculation (the release of semen through the penis during orgasm) may not occur, or it may occur with less force. The recovery period after ejaculation increases with age, and many men older than 55 years are not able to have another erection for 12 to 24 hours after ejaculating. These normal changes related to aging should not be confused with sexual dysfunction or ED; failure to understand these normal changes and to adapt to them may cause stress and anxiety and may complicate erectile function. In ED, the erections are either inadequate for penetration or do not last long enough for completion of sexual performance. In short, the incidence of ED does increase with age, but it is not an expected process of aging.

Age-related changes in sexual function do occur and include a decrease in the amount of smooth muscle in the penis, which may affect erectile function. The sensitivity of the penis can also decrease with age, so that more stimulation is required for an erection. In men older than 60 years, levels of free testosterone in the bloodstream (the active form of testosterone) often decline. Chronic illnesses, which are more common in the elderly, also may decrease testosterone levels, which could affect the vascular response to sexual arousal and libido.

Other factors that aren't necessarily restricted to older men can compound age-related changes; for example, morbid obesity and excessive alcohol consumption over a long period of time decrease testosterone levels.

Is ED preventable?

Many medical conditions that can cause ED are inherited, so, at this point in time, we cannot prevent them. However, conditions such as hypertension, high cholesterol, and diabetes mellitus can be improved by lifestyle changes, such as exercise and proper diet. If you have diabetes mellitus, tight control of your blood sugar level may not totally prevent the occurrence of ED, but it may prevent the ED from progressing. Avoiding excessive alcohol intake and smoking may also help to decrease your risk of ED. Similarly, if you are a long-distance bicycle rider and experience genital numbness when you finish a bike ride, you may want to start using a bicycle seat designed to put less pressure on the perineum.

Is ED curable?

In most cases, ED is not curable—but usually it is treatable. Steps can be taken to help a man have erections— that's what is meant by treatment—but these steps cannot reverse the underlying causes of the dysfunction, which is what is meant by curing a problem. However, in select instances, ED is curable. For example, in young, otherwise healthy men who suffer an acute injury to one of the penile arteries that leads to narrowing or blockage of the artery, a surgical procedure may be performed to reestablish blood flow to the penis. Penile arterial bypass surgery, similar to arterial bypass surgery performed for blocked blood vessels to the heart or the legs, can be performed for damage to penile arteries. Candidates for penile arterial bypass surgery must have only an arterial cause of their ED. There must be no evidence of any other causes of their ED, such as venous leak, neurologic problems, or hormonal abnormalities. In addition, they should not have any underlying disease processes that would adversely affect the bypass, such as elevated cholesterol, diabetes, and high blood pressure, and they may not smoke.

Previously potent men who undergo a nerve-sparing radical prostatectomy and experience postoperative erectile dysfunction may experience a return of their erectile function during the first 2 years after their surgery. Treating the ED early and increasing the penile blood flow may improve erectile function. Finally, men with a psychogenic cause may note resolution of their ED with appropriate treatment of their psychological problems.

Where surgery and psychotherapy aren't able to resolve the problem, other treatment methods, such as medical therapy (oral, intraurethral, and intracavernous) and mechanical devices (the vacuum device or a prosthesis, i.e., a device used to replace the lost normal function of a structure or organ) can help most men achieve a satisfactory erection when desired (Question 75).