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Erectile Dysfunction (ED) in the Elderly
Dr. Munikrishnappa is Adjunct Clinical Instructor, Department of Geriatrics, Saint Louis University School of Medicine, St. Louis, Missouri.
There may be hundreds of things that can go wrong with sex from the male point of view, but scientists divide male sexual dysfunction into three categories. They are: erectile dysfunction (problems with erection), ejaculatory dysfunction (problems with ejaculation) and decrease in libido (loss of interest in sex).
The most familiar to anyone who watches sports on TV is erectile dysfunction, called "ED" for short. The technical definition of ED is the inability to achieve or maintain enough of an erection for satisfactory sexual performance.(1) Most men have the problem at one time ot another — 52% of American men aged 40 to 70 years according to a large study called the Massachusetts Male Aging Study (MMAS).(2) More recent studies have confirmed the common perception that erection problems become more frequent with age.(3)(4)
One reason for this is simply the normal effects of aging on the body. With age, structural changes occur in the penis that make it, like any aging muscle, work less well. Age brings a decreased concentration of elastic fibers and smooth muscle fibers, both of which play an important part in erection.(5) Another factor is age-related disease. ED is frequently associated with atherosclerosis, diabetes and other diseases that also become more common as we age.(6)(7)
An erection is not a simple thing. It requires a complex interaction involving the nervous system, blood flow, hormones and the individual's psychological make-up. It generally occurs in one of three different ways — at night during the REM (rapid eye movement) phase of sleep, from physical touching of the genitals and from psychological stimuli such as a reaction to smell, sight or memory.(8)
The muscles within the penis play a vital role in erection. When these muscles are contracted, only the small amount of blood needed to keep the tissues alive is allowed; this results in a flaccid, or un-erect, penis.(9)
With sexual stimulation, these muscles relax, allow more blood to flow into the penis and cause erection. This happens according to the following complex series of stages. While this may be too technical to be of much use to the average non-medical person, it serves to illustrate the amazing complexity of what may seem a simple bodily function.(10)(11)
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