![]() Endothelial dysfunction secondary to conditions of metabolic syndrome also contributes to the pathophysiology by damaging the source of nitric oxide production in penile tissue. In a study by Rogers et al., stenosis of the internal pudendal artery was similar in comparison to stenosis of coronary arteries (52% vs. Hypertension and other peripheral artery diseases damage these small vessels over time, allowing fewer nutrients and less oxygen to reach the sex organs. The pathogenesis of ED in the elderly is believed to be via systemic atherosclerosis with symptoms manifesting in smaller vessels including the arterial supply to the penis. studied men undergoing cardiac stress testing and found severe coronary artery disease in 43% of men with ED compared to 17% in those without. In fact, it is thought that ED may serve as a harbinger of concomitant cardiovascular disease and even mortality in some cases. Given the prevalence of cardiovascular disease among the elderly, it is important to understand how cardiovascular disease impacts sexual performance. Medications known to cause ED include beta-blockers, thiazide diuretics, and antidepressant medications. ![]() While age alone is a risk factor for ED, additional risk factors among the elderly include hypertension, diabetes, hypogonadism, medication side effects, metabolic syndrome, increased body mass index (BMI), cholesterol, and decreased high-density lipoprotein (HDL). The Massachusetts Male Aging Study reported a 52% prevalence in men ages 40–70 years old. Seventy percent of men over the age of 70 struggle with some degree of ED, compared to 45% in their 60s and 15% in their 40s. It is important for healthcare professionals to address this often-overlooked topic due to the stigmatization that comes with sex in the aging population.ĮD is defined as the inability to achieve or maintain an erection rigid enough for penetration. We will review the pathophysiology of conditions affecting sexual health in the elderly population and outline the treatments available for each condition as it applies to the aging population. Modifiable components of aging include improvement in cardiovascular health, treatment of hormonal deficiency, psychosocial counseling, therapy for erectile dysfunction, and reversal of vulvovaginal atrophy. By understanding the mechanisms of aging, men and women can be optimized for sexual performance with the assistance of lifestyle changes, medications, and even in some cases surgical intervention. Despite 90.9% of patients reporting they wanted their physicians to ask them questions regarding sexual history, only 40.5% report ever having a discussion regarding their sexual life with their doctor. In a survey of 355 individuals, ages 50–90 years, 81.5% were currently involved in one or more sexual relationships. Men and women experience many physiological changes that impact their sexual health as they age. Increased life expectancy in a growing elderly population makes sexual health an important part of patient care. ![]() ![]() By understanding the available tools, a more comprehensive approach can be taken to achieve satisfaction in couples and individuals alike. This review outlines some normal changes due to aging and identifies some current treatment options for a population in which sexual health can be often ignored or dismissed. A multimodal approach involving the physician, patient, and partner will optimize care and may improve the quality of life in the elderly. While aging can diminish drive and desire, proper counseling and treatment may significantly benefit some patients. In women, an understanding of the physiological process of menopause and offering therapy when indicated can improve the quality of sexual health and provide satisfaction to both patient and partner. A combination of testosterone therapy, lifestyle modifications, and therapy for erectile dysfunction relates to sexual satisfaction in men. The pathophysiology is linked between these conditions and treatment of one component can provide symptom relief on a larger scale. Male patients often describe issues related to erectile dysfunction and hypogonadism, and issues with sexual drive. ![]()
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