It is well accepted that ED's prevalence and severity increase with advancing age. Men over the age of 50 are usually afflicted by various organic conditions, including cardiovascular disease (CVD), diabetes, hypertension (high blood pressure), hypercholesterolemia (high cholesterol), and low testosterone; lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH); chronic neurologic conditions such as parkinsonism, stroke, and Alzheimer's; and psychological disorders such as depression and anxiety. Any of these, as well as the use of multiple medications, may contribute to ED. About 48% of men over 50 are affected by different degrees of ED due to physical, intrapsychic, and relational factors - but this does not mean that sexual dysfunction is an inevitable consequence of aging. In the majority of men over 50, sexual interest and desire remain strong.
A specific major risk factor for ED in men 50 and older is atherosclerosis of the pudendal and cavernosal arteries. Atherosclerosis may lead to pathological changes such as penile smooth muscle degeneration and replacement by fibrous tissue, with reduced expandability of the corpora cavernosa, leading to venous leakage.
Prostate problems are another specific risk factor in the aging male. Several recent studies confirmed a close association between sexual dysfunction - namely, ED, ejaculatory incompetence, hypoactive sexual desire, and painful ejaculation - and moderate or severe LUTS secondary to the BPH that commonly occurs in over 50% of men after age 50. In some cases, treatment with certain alpha-blockers, Viagra, or Cialis has improved both the urinary and sexual symptoms.