ERECTILE AND EJACULATORY DYSFUNCTION IN A COMMUNITY-BASED SAMPLE OF MEN 50 TO 78 YEARS OLD: PREVALENCE, CONCERN, AND RELATION TO SEXUAL ACTIVITY

MARCO H. BLANKER, J. L. H. RUUD BOSCH, FRANS P. M. J. GROENEVELD,

ARTHUR M. BOHNEN, AD PRINS, SIEP THOMAS, AND WIM C. J. HOP

ABSTRACT

Objectives. To determine the prevalence rates of erectile and ejaculatory dysfunction, associated bother, and their relation to sexual activity in a population-based sample of elderly men. Methods. Data were collected from 1688 men by way of self-administered questionnaires (including the International Continence Society male sex questionnaire) and measurements at a health center and urology outpatient department.

Results. The prevalence of significant erectile dysfunction (ie, erections of severely reduced rigidity or no erections) increased from 3% in men 50 to 54 years old to 26% in men 70 to 78 years old. In the same age strata, the prevalence of significant ejaculatory dysfunction (ie, ejaculations with significantly reduced volume or no ejaculations) increased from 3% to 35%. Pain or discomfort during ejaculation was rare (1%) and independent of age. In general, men were more concerned about erectile dysfunction than about ejaculatory dysfunction. However, most men had no or only little concern about their dysfunction. The percentage of men who reported being sexually active declined with increasing age and was lower in men

with erectile and ejaculatory dysfunction and in men without a partner. In sexually active men, 17% to 28% had no normal erections, indicating that with advancing age normal erections are not an absolute prerequisite for a sexually active life. Conclusions. Erectile and ejaculatory dysfunction are common in elderly men. The results of this study indicate that these conditions are much less of a problem for older men than previously suggested. UROLOGY 57: 763–768, 2001. © 2001, Elsevier Science Inc.

Sexual Function in Men Older Than 50 Years of Age

What is the problem and what is known about it so far?

Impotence, or erectile dysfunction, is an inability to get or keep an erection firm enough for sexual intercourse. Causes can be psychological or physical. Physical causes include heavy drinking, chronic diseases such as diabetes, and some drugs that are used to treat hypertension and depression. Older men more frequently have erectile dysfunction or risk factors for erectile dysfunction than do younger men. Despite this, we don’t have precise estimates of how common erectile dysfunction is among men older than 50 years of age.

Why did the researchers do this particular study?

To study the prevalence and risk factors for erectile dysfunction in men older than 50 years of age.

Who was studied?

31,742 male health professionals without known prostate cancer, age 53 to 90 years.

How was the study done?

Researchers mailed questionnaires to male health professionals in the United States in 1986 and every 2 years thereafter. In 2000, researchers asked the men about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Men rated their ability in the previous 3 months to have and maintain an erection good enough for intercourse without treatment. Men who rated this ability as poor or very poor were considered to have erectile dysfunction. The researchers then looked at the rates of erectile dysfunction in different age groups and at factors associated with increased risk for erectile dysfunction.

What did the researchers find?

Overall, a third of the men reported erectile dysfunction in the past 3 months. The youngest men reported the highest rates of good sexual function: Seventy-four percent of men younger than age 59 years compared with 10% of men older than age 80 years rated sexual function as good or very good. Many aspects of sexual function, including desire, orgasm, and overall ability, decreased more each decade after age 50 years. Many factors, including increasing age, inactive lifestyle, smoking, obesity, diabetes, stroke, cancer, antidepressant medications, and beta-blocker drugs, were associated with increased risk for erectile dysfunction.

What were the limitations of the study?

Men were not asked how often they had sexual intercourse or whether they got along well with their partner. Information about sexual function was self-reported and not verified by partners. The study looked at whether certain factors were associated with increased risk for erectile dysfunction. It can’t tell us with certainty that treating or changing those conditions will affect erectile dysfunction.

What are the implications of the study?

Erectile dysfunction appears common among older U.S. men. Many aspects of sexual function, including desire, orgasm, and overall ability, decrease as men age past 50 years. Some risk factors for erectile dysfunction, such as obesity, smoking, inactive lifestyle, and certain medications, may be modifiable.

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