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Sexual dysfunction in the older man

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  21 December 2009

M Albersen ,
AW Shindel  and
TF Lue
M Albersen
Affiliation:
Department of Urology, University of California, San Francisco, USA
AW Shindel
Affiliation:
Department of Urology, University of California, San Francisco, USA
TF Lue*
Affiliation:
Department of Urology, University of California, San Francisco, USA
*
Address for correspondence: Tom F Lue, Department of Urology, UCSF, 400 Parnassus Avenue, Campus Box 0738, San Francisco, CA 94143–0738, USA. E-mail: tlue@urology.ucsf.edu
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Summary

Age is strongly associated with risk of sexual dysfunction in both men and women. For many years it was assumed that such a loss of sexuality was natural and inevitable, and therefore little attention was given to sexual behaviour and treatment in this population. However, more recent data have suggested that sexuality remains important into later life for many individuals. Although appreciation of sexuality persists, a decline in sexual activity is typical with advancing age, which is in part attributable to both general health problems and specific sexual dysfunctions, both becoming more prevalent with ageing. The principle sexual health issues in older men include erectile dysfunction and late onset hypogonadism. Although premature ejaculation is prevalent in older men, the bother from this disorder is generally lower in older men. This manuscript consists of a review of the contemporary peer-reviewed literature and attempts to provide insights for the physician treating the geriatric population. We discuss sexual behaviour at older age, and address erectile and androgen biology in older men and the prevalence and aetiology of sexual dysfunction in this population. Furthermore, an overview of contemporary pharmacological treatments for older men's sexual problems is provided.

Keywords

agedmalesexual behaviourerectile dysfunctionhypogonadism(premature) ejaculation
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 4 , November 2009 , pp. 237 - 248
Copyright
Copyright © Cambridge University Press 2009

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References

1DeLamater, J, Moorman, SM. Sexual behavior in later life. J Aging Health 2007; 19: 921–45.Google ScholarPubMed
2Korfage, IJ, Roobol, M, de Koning, HJ, Kirkels, WJ, Schroder, FH, Essink-Bot, ML. Does ‘normal’ aging imply urinary, bowel, and erectile dysfunction? A general population survey. Urology 2008; 72: 3–9.CrossRefGoogle ScholarPubMed
3Lindau, ST, Schumm, LP, Laumann, EO, Levinson, W, O'Muircheartaigh, CA, Waite, LJ. A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357: 762–74.CrossRefGoogle ScholarPubMed
4Smith, LJ, Mulhall, JP, Deveci, S, Monaghan, N, Reid, MC. Sex after seventy: a pilot study of sexual function in older persons. J Sex Med 2007; 4: 1247–53.CrossRefGoogle ScholarPubMed
5Nicolosi, A, Laumann, EO, Glasser, DB, Moreira, ED Jr, Paik, A, Gingell, C. Global Study of Sexual Attitudes and Behaviors Investigators' Group. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology 2004; 64: 991–7.CrossRefGoogle ScholarPubMed
6Araujo, AB, Mohr, BA, McKinlay, JB. Changes in sexual function in middle-aged and older men: longitudinal data from the Massachusetts Male Aging Study. J Am Geriatr Soc 2004; 52: 1502–9.Google ScholarPubMed
7Laumann, EO, Waite, LJ. Sexual dysfunction among older adults: prevalence and risk factors from a nationally representative U.S. probability sample of men and women 57–85 years of age. J Sex Med 2008; 5: 2300–11.CrossRefGoogle ScholarPubMed
8O'Connor, DB, Corona, G, Forti, G et al. Assessment of sexual health in aging men in Europe: development and validation of the European Male Ageing Study sexual function questionnaire. J Sex Med 2008; 5: 1374–85.CrossRefGoogle ScholarPubMed
9Wang, C, Nieschlag, E, Swerdloff, R et al. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Int J Impot Res 2009; 21: 1–8.CrossRefGoogle ScholarPubMed
10Seftel, AD. Male hypogonadism. Part I: Epidemiology of hypogonadism. Int J Impot Res 2006; 18: 115–20.CrossRefGoogle ScholarPubMed
11Camacho, ME, Reyes-Ortiz, CA. Sexual dysfunction in the elderly: age or disease? Int J Impot Res 2005; 17 suppl 1: S52–6.CrossRefGoogle ScholarPubMed
12Buvat, J, Shabsigh, R, Guay, A, Gooren, L, Otavio-Torres, L, Meuleman, E. Hormones, metabolism, aging, and men's health. In Porst, H, Buvat, J (eds), Standard Practice in Sexual Medicine. Blackwell Publishing, 2006: pp. 225–86.CrossRefGoogle Scholar
13Morley, JE. Androgens and aging. Maturitas 2001; 38: 61–73.CrossRefGoogle ScholarPubMed
14Mohr, BA, Guay, AT, O'Donnell, AB, McKinlay, JB. Normal, bound and non-bound testosterone levels in normally ageing men: results from the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf) 2005; 62: 64–73.CrossRefGoogle Scholar
15Baba, K, Yajima, M, Carrier, S et al. Effect of testosterone on the number of NADPH diaphorase-stained nerve fibers in the rat corpus cavernosum and dorsal nerve. Urology 2000; 56: 533–8.CrossRefGoogle ScholarPubMed
16Traish, AM, Goldstein, I, Kim, NN. Testosterone and erectile function: from basic research to a new clinical paradigm for managing men with androgen insufficiency and erectile dysfunction. Eur Urol 2007; 52: 54–70.CrossRefGoogle ScholarPubMed
17Park, KH, Kim, SW, Kim, KD, Paick, JS. Effects of androgens on the expression of nitric oxide synthase mRNAs in rat corpus cavernosum. BJU Int 1999; 83: 327–33.CrossRefGoogle ScholarPubMed
18Traish, AM, Park, K, Dhir, V, Kim, NN, Moreland, RB, Goldstein, I. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology 1999; 140: 1861–8.CrossRefGoogle ScholarPubMed
19Zhang, XH, Morelli, A, Luconi, M et al. Testosterone regulates PDE5 expression and in vivo responsiveness to tadalafil in rat corpus cavernosum. Eur Urol 2005; 47: 409–16.CrossRefGoogle ScholarPubMed
20Yang, R, Huang, YC, Lin, G et al. Lack of direct androgen regulation of PDE5 expression. Biochem Biophys Res Commun 2009; 380: 758–62.CrossRefGoogle ScholarPubMed
21Seftel, A. Male hypogonadism. Part II: etiology, pathophysiology, and diagnosis. Int J Impot Res 2006; 18: 223–8.CrossRefGoogle ScholarPubMed
22Emmelot-Vonk, MH, Verhaar, HJ, Nakhai-Pour, HR, Grobbee, DE, Van Der Schouw, YT. Effect of testosterone supplementation on sexual functioning in aging men: a 6-month randomized controlled trial. Int J Impot Res 2009; 21: 129–38.CrossRefGoogle Scholar
23Stanworth, RD, Jones, TH. Testosterone for the aging male; current evidence and practice. Clin Interv Aging 2008; 3: 25–44.Google Scholar
24Gruenewald, DA, Matsumoto, AM. Testosterone supplementation therapy for older men: potential benefits and risks. J Am Geriatr Soc 2003; 51: 101–15.CrossRefGoogle ScholarPubMed
25Er, F, Michels, G, Gassanov, N, Rivero, F, Hoppe, UC. Testosterone induces cytoprotection by activating ATP-sensitive K+ channels in the cardiac mitochondrial inner membrane. Circulation 2004; 110: 3100–7.CrossRefGoogle ScholarPubMed
26Dobs, AS, Morgentaler, A. Does testosterone therapy increase the risk of prostate cancer? Endocr Pract 2008; 14: 904–11.CrossRefGoogle ScholarPubMed
27Morgentaler, A. Testosterone therapy in men with prostate cancer: scientific and ethical considerations. J Urol 2009; 181: 972–9.CrossRefGoogle ScholarPubMed
28NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83–90.CrossRefGoogle Scholar
29Lue, TF. Erectile dysfunction. N Engl J Med 2000; 342: 1802–13.CrossRefGoogle ScholarPubMed
30Dean, RC, Lue, TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am 2005; 32: 379–95.CrossRefGoogle ScholarPubMed
31Porst, H. Sharlip, ID. Anatomy and physiology of erection. In Porst, H, Buvat, J (eds), Standard Practice in Sexual Medicine. Blackwell Publishing, 2006: pp. 31–42.CrossRefGoogle Scholar
32Corona, G, Mannucci, E, Mansani, R et al. Aging and pathogenesis of erectile dysfunction. Int J Impot Res 2004; 16: 395–402.Google ScholarPubMed
33Sampson, N, Untergasser, G, Plas, E, Berger, P. The ageing male reproductive tract. J Pathol 2007; 211: 206–18.CrossRefGoogle ScholarPubMed
34Gonzalez-Cadavid, NF, Rajfer, J. Molecular pathophysiology and gene therapy of aging-related erectile dysfunction. Exp Gerontol 2004; 39: 1705–12.CrossRefGoogle ScholarPubMed
35Giuliano, F. New horizons in erectile and endothelial dysfunction research and therapies. Int J Impot Res 2008; 20 suppl 2: S2–8.CrossRefGoogle ScholarPubMed
36Rajasekaran, M, White, S, Baquir, A, Wilkes, N. Rho-kinase inhibition improves erectile function in aging male Brown-Norway rats. J Androl 2005; 26: 182–8.CrossRefGoogle ScholarPubMed
37Wespes, E. Smooth muscle pathology and erectile dysfunction. Int J Impot Res 2002; 14 suppl 1: S17–21.CrossRefGoogle ScholarPubMed
38Wespes, E. Erectile dysfunction in the ageing man. Curr Opin Urol 2000; 10: 625–8.CrossRefGoogle ScholarPubMed
39Albersen, M, Joniau, S, Claes, H, Van Poppel, H. Preclinical evidence for the benefits of penile rehabilitation therapy following nerve-sparing radical prostatectomy. Adv Urol 2008; 59: 48–68.Google Scholar
40Sefteld, AD. Diagnosis of erectile dusfunction. In Porst, H, Buvat, J (eds), Standard Practice in Sexual Medicine. Blackwell Publishing, 2006: pp. 59–74.CrossRefGoogle Scholar
41Lue, TF, Giuliano, F, Montorsi, F et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2004; 1: 6–23.CrossRefGoogle ScholarPubMed
42Wespes, E, Amar, E, Hatzichristou, D et al. EAU Guidelines on erectile dysfunction: an update. Eur Urol 2006; 49: 806–15.CrossRefGoogle ScholarPubMed
43Eros, D, Szántai-Kis, C, Kiss, R et al. Structure–activity relationships of PDE5 inhibitors. Curr Med Chem 2008; 15: 1570–85.CrossRefGoogle ScholarPubMed
44Shindel, AW. 2009 update on phosphodiesterase type 5 inhibitor therapy. Part 1: Recent studies on routine dosing for penile rehabilitation, lower urinary tract symptoms, and other indications. J Sex Med 2009; 6: 1794–808.CrossRefGoogle ScholarPubMed
45Wrishko, R, Sorsaburu, S, Wong, D, Strawbridge, A, McGill, J. Safety, efficacy, and pharmacokinetic overview of low-dose daily administration of tadalafil. J Sex Med 2009; 6: 2039–48.CrossRefGoogle ScholarPubMed
46Greco, EA, Spera, G, Aversa, A. Combining testosterone and PDE5 inhibitors in erectile dysfunction: basic rationale and clinical evidences. Eur Urol 2006; 50: 940–7.CrossRefGoogle ScholarPubMed
47Jannini, EA, Isidori, AM, Gravina, GL et al. The ENDOTRIAL study: a spontaneous, open-label, randomized, multicenter, crossover study on the efficacy of sildenafil, tadalafil, and vardenafil in the treatment of erectile dysfunction. J Sex Med 2009; 6: 2547–60.CrossRefGoogle ScholarPubMed
48Richter, S, Vardi, Y, Ringel, A, Shalev, M, Nissenkorn, I. Intracavernous injections: still the gold standard for treatment of erectile dysfunction in elderly men. Int J Impot Res 2001; 13: 172–5.CrossRefGoogle ScholarPubMed
49Rooney, M, Pfister, W, Mahoney, M, Nelson, M, Yeager, J, Steidle, C. Long-term, multicenter study of the safety and efficacy of topical alprostadil cream in male patients with erectile dysfunction. J Sex Med 2009; 6: 520–34.CrossRefGoogle ScholarPubMed
50McMahon, CG, Althof, SE, Waldinger, MD et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med 2008; 5: 1590–606.CrossRefGoogle Scholar