Journal Mobile Options
Table of Contents
Vol. 58, No. 1, 2012
Issue release date: December 2011
Section title: Clinical Section / Mini-Review
Free Access
Gerontology 2012;58:3–14

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

Albersen M.a, b · Orabi H.a, c · Lue T.F.a
aDepartment of Urology, University of California at San Francisco, San Francisco, Calif., USA; bDepartment of Urology, University Hospitals Leuven, Leuven, Belgium; cDepartment of Urology, Assiut University, Assiut, Egypt
email Corresponding Author

Maarten Albersen, MD

Laboratory of Experimental Urology, Department of Urology

University Hospitals Leuven, Herestraat 49

BE–3000 Leuven (Belgium)

Tel. +32 16 34 69 30, E-Mail


  1. Lindau 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;357:762–774.
  2. Smith 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;4:1247–1253.
  3. NIH Consensus Conference: Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993;270:83–90.
  4. Uckert S, Mayer ME, Stief CG, Jonas U: The future of the oral pharmacotherapy of male erectile dysfunction: things to come. Expert Opin Emerg Drugs 2007;12:219–228.
  5. Hatzimouratidis K, Hatzichristou DG: A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient? Drugs 2005;65:1621–1650.
  6. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB: Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol 1994;151:54–61.
  7. Corona G, Lee DM, Forti G, O’Connor DB, Maggi M, O’Neill TW, et al: Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J Sex Med 2010;7:1362–1380.
  8. Russell ST, Khandheria BK, Nehra A: Erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2004;79:782–794.
  9. Albersen M, Shindel AW, Lue TF: Sexual dysfunction in the older man. Rev Clin Gerontol 2009;19:237–248.
    External Resources
  10. Ayta IA, McKinlay JB, Krane RJ: The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999;84:50–56.
  11. Laumann EO, Waite LJ: Sexual dysfunction among older adults: prevalence and risk factors from a nationally representative US probability sample of men and women 57–85 years of age. J Sex Med 2008;5:2300–2311.
    External Resources
  12. Saigal CS, Wessells H, Pace J, Schonlau M, Wilt TJ: Urologic Diseases in America Project. Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med 2006;166:207–212.
  13. Lue TF: Erectile dysfunction. N Engl J Med 2000;342:1802–1813.
  14. Albersen M, Shindel AW, Mwamukonda KB, Lue TF: The future is today: emerging drugs for the treatment of erectile dysfunction. Expert Opin Emerg Drugs 2010;15:467–480.
  15. Hannan JL, Blaser MC, Oldfield L, Pang JJ, Adams SM, Pang SC, et al: Morphological and functional evidence for the contribution of the pudendal artery in aging-induced erectile dysfunction. J Sex Med 2010;7:3373–3384.
  16. El-Sakka AI, Yassin AA: Amelioration of penile fibrosis: myth or reality. J Androl 2010;31:324–335.
  17. Rudner XL, Berkowitz DE, Booth JV, Funk BL, Cozart KL, D’Amico EB, El-Moalem H, Page SO, Richardson CD, Winters B, Marucci L, Schwinn DA: Subtype specific regulation of human vascular alpha(1)-adrenergic receptors by vessel bed and age. Circulation 1999;100:2336–2343.
  18. Christ GJ, Stone B, Melman A: Age-dependent alterations in the efficacy of phenylephrine-induced contractions in vascular smooth muscle isolated from the corpus cavernosum of impotent men. Can J Physiol Pharmacol 1991;69:909–913.
  19. Vanhoutte PM: Ageing and endothelial dysfunction. Eur Heart J Suppl 2002;4(suppl A):A8–A17.
    External Resources
  20. Musicki B, Kramer MF, Becker RE, Burnett AL: Age-related changes in phosphorylation of endothelial nitric oxide synthase in the rat penis. J Sex Med 2005;2:347–355.
  21. Aversa A, Bruzziches R, Francomano D, Natali M, Gareri P, Spera G: Endothelial dysfunction and erectile dysfunction in the aging man. Int J Urol 2010;17:38–47.
  22. Park CS, Ryu SD, Hwang SY: Elevation of intracavernous pressure and NO-cGMP activity by a new herbal formula in penile tissues of aged and diabetic rats. J Ethnopharmacol 2004;94:85–92.
  23. Wespes E: The ageing penis. World J Urol 2002;20:36–39.
  24. Ferrini MG, Davila HH, Valente EG, Gonzalez-Cadavid NF, Rajfer J: Aging-related induction of inducible nitric oxide synthase is vasculo-protective to the arterial media. Cardiovasc Res 2004;61:796–805.
  25. Ferrini M, Magee TR, Vernet D, Rajfer J, Gonzalez-Cadavid NF: Aging-related expression of inducible nitric oxide synthase and markers of tissue damage in the rat penis. Biol Reprod 2001;64:974–982.
  26. Traish AM, Munarriz R, O’Connell L, Choi S, Kim SW, Kim NN, et al: Effects of medical or surgical castration on erectile function in an animal model. J Androl 2003;24:381–387.
    External Resources
  27. Rogers RS, Graziottin TM, Lin CS, Kan YW, Lue TF: Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. Int J Impot Res 2003;15:26–37.
  28. Traish A, Kim N: The physiological role of androgens in penile erection: regulation of corpus cavernosum structure and function. J Sex Med 2005;2:759–770.
  29. Traish AM, Kim N: Weapons of penile smooth muscle destruction: androgen deficiency promotes accumulation of adipocytes in the corpus cavernosum. Aging Male 2005;8:141–146.
  30. Lue TF, Broderick GA: Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation; in Campbell-Walsh Urology ed 9. Amsterdam, Elsevier, 2007.
  31. Jackson G, Rosen RC, Kloner RA, Kostis JB: The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine. J Sex Med 2006;3:28–36.
  32. Korfage IJ, Pluijm S, Roobol M, Dohle GR, Schroder FH, Essink-Bot ML: Erectile dysfunction and mental health in a general population of older men. J Sex Med 2009;6:505–512.
  33. Saltzman EA, Guay AT, Jacobson J: Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation. J Urol 2004;172:255–258.
  34. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, et al: SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther 1997;23:176–194.
  35. Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 1999;19:67–85.
  36. Fujisawa M, Sawada K: Clinical efficacy and safety of sildenafil in elderly patients with erectile dysfunction. Arch Androl 2004;50:255–260.
  37. Bella AJ, Deyoung LX, Al-Numi M, Brock GB: Daily administration of phosphodiesterase type 5 inhibitors for urological and nonurological indications. Eur Urol 2007;52:990–1005.
  38. Shindel AW: Update on phosphodiesterase type 5 inhibitor therapy part 1: recent studies on routine dosing for penile rehabilitation, lower urinary tract symptoms, and other indications (CME). J Sex Med 2009;6:1794–1808.
  39. Konstantinopoulos A, Giannitsas K, Athanasopoulos A, Spathas D, Perimenis P: The impact of daily sildenafil on levels of soluble molecular markers of endothelial function in plasma in patients with erectile dysfunction. Expert Opin Pharmacother 2009;10:155–160.
  40. Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan H: Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004;172:658–663.
  41. Giuliano F, Donatucci C, Montorsi F, Auerbach S, Karlin G, Norenberg C, et al: Vardenafil is effective and well-tolerated for treating erectile dysfunction in a broad population of men, irrespective of age. BJU Int 2005;95:110–116.
  42. Brock GB, McMahon CG, Chen KK, Costigan T, Shen W, Watkins V, et al: Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002;168:1332–1336.
  43. Hatzimouratidis K, Hatzichristou D: Phosphodiesterase type 5 inhibitors: the day after. Eur Urol 2007;51:75–88.
  44. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al: Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010;57:804–814.
  45. Ning H, Xin ZC, Lin G, Banie L, Lue TF, Lin CS: Effects of icariin on phosphodiesterase-5 activity in vitro and cyclic guanosine monophosphate level in cavernous smooth muscle cells. Urology 2006;68:1350–1354.
  46. Shindel AW, Xin ZC, Lin G, Fandel TM, Huang YC, Banie L, et al: Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. J Sex Med 2010;7:1518–1528.
  47. Jones RW, Rees RW, Minhas S, Ralph D, Persad RA, Jeremy JY: Oxygen free radicals and the penis. Expert Opin Pharmacother 2002;3:889–897.
  48. Hellstrom WJ, Montague DK, Moncada I, Carson C, Minhas S, Faria G, et al: Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 2010;7:501–523.