Evaluation and Treatment of Erectile Dysfunction in the Aging Male: A Mini-Review

Abstract

Before the 20th century, individuals often did not live beyond the reproductive years, and sexuality of the elderly was not an issue. However, in the current era it is known that as life expectancy improves, both men and women are seeking to preserve their sexuality into old age. While the appreciation of sexuality persists with aging, a decline in sexual activity is typically seen with, and can be attributed to both general health problems as well as specific sexual dysfunctions. Erectile dysfunction is the most frequently diagnosed sexual dysfunction in the older male population. This mini-review provides an overview of contemporary literature concerning epidemiology, pathophysiology, assessment and treatment of erectile dysfunction in the aging male.

REVITALISE: A Large Observational Study Assessing the Safety and Effectiveness of Vardenafil in Men With Erectile Dysfunction and Metabolic Syndrome

“…This is an important issue because the prevalence and severity of ED increase with age 38 owing to multiple pathophysiologic changes in erectile mechanisms, such as a decrease in endogenous nitric oxide production 39 . It has been proposed that combining testosterone supplementation with a PDE5 inhibitor might improve its efficacy by increasing nitric oxide bioavailability and helping to maintain the health of erectile tissue and surrounding nerves 39, 40. Further studies to determine the benefit of using a combination treatment strategy in elderly men are warranted.…”

The Old Made New: Natural Compounds against Erectile Dysfunction

“…In particular, the prevalence of ED rises in aging subjects as a result, primarily, of a progressive worsening of conditions influencing erectile biology [13]. Briefly, in the aging male, the vascular supply to the penis becomes defective due to atherosclerotic alterations [14].…”

“…degradation of cGMP by PDE5 promoting, as a result, the relaxation of penile smooth muscle [20]. Through the years, their growing success was helped by their good safety profile in both younger and older men, even if with a decreased efficacy in the elderly [13,[22][23][24]. Traditionally, PDE5-Is are divided according to their different rates of absorption and duration of effect: while vardenafil shows the quickest onset time, tadalafil is reported to have the longest duration of action [21].…”

Erectile Dysfunction and Cardiovascular Disease: A Review

“…Given their ease of use and excellent safety profile, PDE-5 inhibitors are recommended as first line drug therapy; however, these drugs demonstrate lower response rates in older men. The reasons for this age discrepancy include an age-associated decrease in endogenous NO production, which is further diminished by other comorbidities [87]. Of the 30-40% of patients who do not initially respond, counseling and daily low-dose administration may be helpful, and in men with low testosterone, testosterone replacement therapy has been shown to improve response to PDE-5 inhibitor therapy by increasing the bioavailable NO in the cavernous smooth muscle tissue [88].…”