Old Age : As men age there is a natural slowing down of many bodily functions. From a sexual viewpoint, this may occur as decreased firmness of erections, shorter lasting erections or a longer “recovery time” in between erections These changes may be caused by a decreased production of testosterone, decreased blood flow or other diseases that are more common in men as they age. Most commonly, the sexual changes associated with old age are due to a combination of the factors discussed in more detail below.


Decreased Blood Flow : A decrease in the blood flow to the penis will affect the quality of erections. The erections will be weak and/or short lasting.


Diabetes : Diabetes can interfere with erections in a number of ways, and erectile problems tend to get worse the longer a man has diabetes. Half of all men with diabetes experience some degree of erectile dysfunction. Diabetes can affect the sending and receiving of nerve impulses. This condition is called peripheral neuropathy and may also affect the hands and feet of diabetics. Without good nerve function, erections are more difficult to achieve. Diabetes may affect the blood flow to the penis. Men with diabetes often experience decreased quality or number of erections. Healthy blood vessels are needed for the engorgement of penile tissue that leads to erection.


High Blood Pressure (Hypertension) : Hypertension can affect erections either by the changes it causes in the blood vessels, or by the medications used for treatment. Hypertension may affect the veins, allowing the blood that does rush into the penis to exit just as quickly. The effects of hypertension on erectile function are cumulative over time and may occur even before a man knows he has hypertension.


Pelvic Surgery (prostate, bladder, rectal) : When surgery is performed in the pelvic area, injury to the nerves and or blood vessels may result. Even with “nerve sparing” procedures, the nerves may be temporarily or permanently altered. With extensive surgery for bladder or rectal cancers, a large amount of tissue is removed and impotence may occur.


Spinal Cord Injury, Multiple Sclerosis, and Other Nervous System Disorders : An injury to the spinal cord disrupts the nerve pathways necessary for an erection. Sometimes men with a spinal cord injury may get reflex erections. However, these are unpredictable and usually very short lasting. Multiple sclerosis interferes with the nerve impulses in the body. Also, multiple sclerosis may lead to generalized weakness and immobility which make it difficult to get an erection. Any other disorder which interferes with the nervous system can make good erections difficult or impossible.


Hormonal Problems : The hormones play an important part in sexual function. They are responsible for the sex drive (also called libido). Hormonal imbalances such as low testosterone or high prolactin can disrupt the libido.


Depression and Psychological Problems : Depression may lead to erectile dysfunction by a loss of sex drive, or by the medications used for treatment. Problems with premature ejaculation and the anxiety associated with it may lead to erectile problems.


Cigarette Smoking, Excessive Use of Alcohol, Drug Abuse : Habits such as smoking, heavy alcohol use and recreational drug abuse may inhibit erectile function. The effects may be temporary or permanent. Temporary erectile dysfunction may occur as a result of ingestion of large amounts of alcohol. Permanent effects may occur from the effects of smoking on the blood vessels or alcohol on the nerves. substances added to recreational drugs may damage both the vessels and nerves.


Medications : Medications used to treat a variety of diseases can affect erectile functioning. Some of the more common are drugs used to treat high blood pressure and depression. Switching medications may help restore sexual function. Changes in medication must always be ordered and supervised by a medical professional. Talk to your medical doctor about the possibility of switching blood pressure medications. There are many medications for hypertension which do not cause erection problems.


Peyronie’s Disease : Peyronie’s disease is a bending of the erect penis which is often painful. The exact cause of Peyronie’s is not known, but there may be some association with trauma. This condition can lead to impotence and/or inability to have intercourse due to the curvature.