Is Erectile Dysfunction a Natural Part of Aging?

Erectile dysfunction or disorder (ED)—the inability to develop and maintain an erection for satisfactory sexual intercourse or activity—is the most commonly reported sex problem in people with penises, affecting between 12 million and 30 million individuals in the United States.

ED becomes more common as people get older because testosterone levels drop over time. In fact, age is the variable most strongly associated with ED. Approximately 40% of people with penises have some experience of ED by age 40, and by age 70, nearly 70% of people with penises are impacted to some degree. At age 40, 5% of males are diagnosed with complete ED, but this number increases to 15% by age 70.

In this article, we'll discuss why ED becomes more common with age as well as prevention and treatment options.

Mature couple upset in bed


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How Erections Occur

With erectile dysfunction (ED), it is hard for a person to get or keep an erection that is firm enough for sex. The ability to develop and maintain an erection is largely governed by sexual arousal, a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels. Physical or psychological factors can impact sexual function, desire, and arousal, all of which can cause ED. 

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, which are made of spongy muscle tissue called the corpus cavernosum (CC). During an erection, the CC fills up with blood, making the penis firm.

After orgasm, the muscles of the penis relax, releasing blood back into the circulation system. As a result, the erection comes down, the penis is soft and limp, and the person’s urogenital system returns to its pre-arousal state.

Physical Causes of Erectile Dysfunction

Occasional ED is common and not usually indicative of a problem, but more frequent bouts may disrupt your life. ED that occurs due to a physical cause usually happens for one of the following reasons:

  • You are getting older. Some people simply lose the ability to maintain an erection because testosterone levels decrease with age.
  • You have a condition that hinders blood from entering the penis, like atherosclerosis, diabetes, high blood pressure, or tobacco use (smoking).
  • Damage to the penis (such as trauma or pelvic surgery) does not allow it to trap blood during an erection.
  • Damage to nerves in the brain and spinal cord, such as nerve damage from a stroke or autoimmune disorders like multiple sclerosis, disrupt nerve signals from reaching the penis.
  • Injury to the penis during surgery or radiation, especially during treatment of prostate, colon-rectal, or bladder cancer, hinders your ability to get and maintain an erection.
  • Side effects of cancer chemotherapy or cancer treatment near the pelvis can affect the penis's functionality.
  • Side effects of medications used to treat other health problems negatively impact erections.

Other common causes of ED include:

  • Obesity
  • Metabolic syndrome 
  • Parkinson's disease
  • Drug use. Illicit drugs and certain prescription medications like barbiturates, antidepressants, and anti-seizure medications can actually cause or exacerbate ED or loss of libido as a side effect. The same is true of some drugs used to treat the previously mentioned medical conditions—including antihypertensives to treat high blood pressure and diuretics used for heart disease—so discuss all medication changes with a healthcare professional.
  • Peyronie's disease, which causes scar tissue to develop inside the penis
  • Alcoholism
  • Obstructive sleep apnea and other sleep disorders (which can be associated with lower testosterone levels)
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Hormonal abnormalities. These can happen for a number of reasons, including certain medical conditions that increase prolactin, steroid abuse by bodybuilders, hypo- or hyperthyroidism (too little or too much thyroid hormone), or hormone therapy for cancer treatment. Rarely are chronically low testosterone levels alone the cause of ED.

The following risk factors put some people with penises at a higher risk of developing ED in their lifetime:

  • Diabetes: It’s been estimated that 35% to 50% of diabetic patients who have penises struggle with ED. Uncontrolled blood sugar levels damage arteries, causing them to harden (a process called atherosclerosis), which impairs blood flow and interferes with the nerves that help create and maintain erections.
  • Hypertension: High blood pressure also damages blood vessels. One study found that 61% of males with high blood pressure have reported experiencing ED. 
  • Kidney disease: Kidneys that aren’t in good working order can impact nerve functioning, energy levels, and the hormones that circulate in our bodies. And when those things falter, erections can suffer.
  • Cardiovascular disease: One of the earliest signs of heart disease is the inability of blood vessels in the penis to enlarge, allowing enough blood flow to get and maintain an erection. One study found that people over the age of 69 with ED had more than twice the number of heart attacks, cardiac arrests, and strokes than similarly aged people without ED. Because of this, all people with ED should have a cardiovascular workup with their healthcare provider.
  • Prostate disease: The prostate is a small gland that lies between the penis and the bladder. Certain drugs and surgery used to treat an enlarged prostate or prostate cancer can cause ED. 
  • Obesity: Obesity causes inflammation throughout the body, which affects the integrity of blood vessels that supply the penis. One study found that 73% of males with abdominal obesity had some degree of ED. Obesity may also be associated with lower testosterone, which can affect erectile function.
  • Obstructive sleep apnea (OSA): Blockage of upper airways during sleep impedes air and consequently blood flow, increasing the risk of ED. It’s been estimated that 69% of males with OSA have ED.

Psychological Causes of Erectile Dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety, or other mental health conditions. Of note, research shows that people with cardiovascular disease are more likely to be depressed, so they should be screened for depression if they develop ED.
  • Stress at home or at work
  • Relationship problems due to stress, poor communication, or other concerns
  • Anxiety about sexual performance

Treating Erectile Dysfunction

Effectively treating ED is highly dependent on finding the root cause of the disorder. Some providers use a questionnaire to supplement their medical history and physical exam. Questionnaires may rate your ability to initiate and keep erections, gauge your satisfaction with sex, and help identify any problems with orgasm.

Your healthcare provider may also order blood tests and collect a urine sample to look for health problems that may cause ED. Gathering this information will help your provider determine the best and most specific treatments for your erectile dysfunction.

If the root of your ED is physical, your doctor or another healthcare provider may point out certain lifestyle-related risk factors like smoking or an unhealthy diet that you can change. They may also change medications that you are taking for another health condition that may be causing your ED, such as some antidepressants and high blood pressure drugs. 

The most common treatment for ED is a prescription oral pill that can help you get and maintain an erection, such as:

  • Viagra (sildenafil)
  • Levitra or Staxyn (vardenafil)
  • Cialis (tadalafil)
  • Stendra (avanafil)

These medications all work in the same way by helping the muscles of the penis to relax and fill with blood prior to and during sex.

These medications differ in how quickly they work. For example, Viagra, the most popular of these supplements, generally starts to work 30 to 60 minutes after you take it, but Cialis works in 16 to 45 minutes after consumption.

No matter which of these medications you take, seek immediate medical attention if you develop vision or hearing loss or an erection that lasts for more than four hours, a condition called priapism.

ED Meds and Nitrates


ED medications like Viagra should never be taken with nitrates or alpha-blockers, as the combination can lead to a sudden drop in blood pressure. Never stop taking medication for another health condition or start taking ED medications without first speaking with a healthcare provider.

Other Treatment Options

Testosterone therapy: This is helpful in those with chronically low testosterone levels, but it is rarely helpful in those with low testosterone due to age or circulatory or nerve dysfunction. However, while testosterone replacement may not be the only management for age-related ED, there is a synergy between testosterone and ED medication that may be helpful.

Penile injections: People who want more immediate erections may opt to inject a prescription medicine called alprostadil (or a mixture of papaverine, phentolamine, and alprostadil called Trimix) into the penis, causing it to become filled with blood. If you do not like the idea of injecting yourself, you may prefer to insert a suppository of alprostadil—a solid piece of medicine that dissolves—into the urethra.

Penile pumps: People who experience side effects from oral ED pills may find a vacuum pump beneficial. A vacuum device is used during intercourse to prevent blood from flowing back into the body. It cannot be used for long, however, as the ring portion of the device must be removed after 30 minutes to avoid skin irritation and numbness. 

Surgery: This is a last resort and usually consists of a urologist implanting a device (possibly an inflatable penile prosthesis) to make the penis erect, or rebuilding arteries to increase blood flow to the penis.

Therapy: If the root cause of your ED is psychological, cognitive behavioral therapy, couples therapy, or counseling to talk through your issues or trauma and treat your anxiety and depression may be helpful.

Coping

ED can be especially disheartening because it can make you feel unable to meet your sexual needs and desires or those of your partner. Talking to your partner is a good place to start. They can help you cope with the condition and rethink sex. Next, you may want to talk to a doctor to figure out the root cause and identify potential treatment options. 

People with ED would probably agree that there is a profound emotional component to the condition. They may feel insecure about their sexual performance, and may begin to experience anxiety and depression. Talk therapy is a useful tool to unpack those thoughts and feelings, and sometimes it’s all that is needed to jumpstart one's sex life.

It’s also important to note that anxiety and depression can be both a cause and a symptom of ED. In other words, anxiety or depression can affect your sexual arousal and therefore cause ED, but not being able to perform in bed may also make you anxious and nervous or lead to sexual avoidance, which can further exacerbate your ED.

Talking to your partner about ED can be understandably difficult, but a part of any healthy relationship and sex life is communication. Talking about your difficulties takes the pressure off you and informs your partner of what’s going on. It can also serve as an opportunity to engage in more pro-healthy behaviors together, such as quitting smoking, exercising more, and eating a heart-healthy diet. 

Joining a support group and reimagining your sex life are also worthwhile coping mechanisms. Remember that intimacy is not dependent on penile penetration. Foreplay and intimate touching are also important components of a healthy sex life.

A Word From Verywell

As you get older, your chances of experiencing erectile dysfunction increase, but it's far from a definite eventuality. ED is a complex condition, with physical, emotional, social, and practical components. Despite its complexity, it does not have to define you or your relationships.

Many people successfully cope with ED by communicating with their partners and a healthcare professional. What's more, there are more treatment options available than ever and ED is becoming less taboo to talk about by the day.

A supportive environment is important whether the cause of your ED is physical or psychological. Remember that communication is key when dealing with erectile dysfunction and that you can enjoy a great sex life despite it.

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10 Sources
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