By James Roland
Erectile dysfunction (ED) is very common. Although it can affect men of all ages, it occurs more often in older adults and those with certain medical conditions, like diabetes.
Older research estimates that about 70 percent of men ages 70 and older report being “sometimes able” or “never able” to achieve an erection adequate for satisfactory intercourse, compared with just 30 percent of older men who report being “usually able” or “always or almost always able.”
Though it isn’t inevitable for everyone, ED is considered a normal part of aging as its risk factors include conditions common among older adults, such as:
- cardiovascular disease
- reduced levels of testosterone
- use of medications that treat conditions including:
- high blood pressure
- chronic pain
- prostate disorders
- long-term, heavy substance use, including alcohol and tobacco
- psychological conditions, including stress, anxiety, and depression
- overweight or obesity
Sometimes treating an underlying condition can cure or reverse ED. However, most ED treatments are designed for temporary symptom relief, so an erection can be achieved that’s satisfactory for both the person with ED and their partner.
Best ED treatment for 70s and over
A variety of ED treatments are currently available. Researchers continue to develop new medications and other therapies.
For older adults, treating ED may require a two-prong approach:
- treat underlying conditions that contribute to ED, such as cardiovascular disease and diabetes
- address ED symptoms with oral medications or other alternatives
The most commonly used ED medications among older adults are from a class of drugs called phosphodiesterase-5 (PDE5) inhibitors.
PDE5 inhibitors block the activity of an enzyme in the walls of blood vessels. As a result, blood vessels are able to relax. In the penis this means more blood can fill the blood vessels, producing an erection.
The main PDE5 inhibitors available with a prescription are:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
- avanafil (Stendra)
Except for avanafil, all of those medications are available in both brand-name and generic versions. (As of 2020, avanafil is still only sold as the brand-name drug Stendra.)
More ED medications are in the testing and approval process. In the United States, PDE5 inhibitors require a prescription. None are available over the counter.
Side effects from these medications are usually temporary and minor. More serious reactions such as priapism (a painful, prolonged erection) may occur in some cases.
Typical side effects include:
- stomach and back pain
Research indicates that PDE5 inhibitors are appropriate for most older adults.
Each medication works a little differently. For example, vardenafil usually works faster than the other medications, while tadalafil’s effects last longer.
Tadalafil is often a good choice for older adults who also have an enlarged prostate because it can be prescribed for daily dosing.
Sildenafil should be taken on an empty stomach and may require dose adjustments to get it right.
Talk with your doctor to find the right ED medication for you and your lifestyle.
Who shouldn’t take these meds
People who have certain health conditions, including heart disease, shouldn’t take these medications.
People who take certain medications to manage another health condition shouldn’t take PDE5 inhibitors either. This includes nitrates and alpha-blockers.
Older men are more likely to have heart disease or take nitrates for blood pressure.
Your doctor will take into consideration your overall health and lifestyle when prescribing an ED medication.
For older adults who find that PDE5 inhibitors don’t produce the results they want or who don’t like their side effects, self-administered penile injections may be a preferred option.
The three most widely used medications for penile injection therapy include:
- prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex, MUSE)
To use these, you inject the medication into the penis with a syringe before intercourse. While this approach often results in some minor, temporary pain, research shows that about 90 percent of men who used alprostadil were satisfied with the results.
These medications are often used in combination with other treatments and require dosing adjustments. Your first injection should be done in your doctor’s office so they can make sure you do it correctly and safely.
Who shouldn’t use these
Older adults who feel they or their partner can’t carefully administer an injection should consider other options, whether due to lack of dexterity or other reasons.
Taking blood thinner medications is another reason to avoid injectables.
If oral or injected medications can’t be used or don’t provide desired results, another ED treatment is an inflatable prosthesis surgically implanted in the penis.
In a 2012 study of men ages 71 to 86, researchers found that an inflatable penile prosthesis was well tolerated and largely effective in treating ED.
Because it’s a surgical procedure, it carries the slight risks of infection or other complications. It’s important to go over all the risks and benefits of this treatment approach with your doctor. Together you can decide whether your overall health makes you a good candidate for the procedure.
It’s also important to note that an implant is permanent. It would only be removed under certain circumstances, such as infection or malfunction.
Once you have a penile implant, it permanently alters the penile anatomy. This means other treatments can’t be used after it’s placed.
While not a specific treatment, making some changes in your day to day can make a noticeable difference in erectile function. Some helpful strategies include:
Why these treatments?
PDE5 inhibitors are widely used among older adults because they’re generally safe, effective, and convenient.
Because ED medications are taken on an “as needed” basis, there isn’t the same concern about missing a dose that there may be with potentially lifesaving drugs, such as high blood pressure medications or blood thinners.
Older adults who find the side effects of PDE5 inhibitors too uncomfortable may prefer injections. Those who are used to self-administering medications, such as people who give themselves insulin shots to treat diabetes, may be more comfortable with penile injections.
Penile implants avoid the concerns about side effects altogether. And since the body’s response to medications can change over time, an implanted prosthesis also means not having to worry about changing medications or dosages.
How effective is it?
ED treatments vary in how long each one is effective, as well as side effects. Regardless of which kind of treatment you choose, there are some important facts to keep in mind:
- ED medications typically take 30 to 60 minutes to become effective. Medications such as sildenafil usually wear off in about 4 hours or so, while tadalafil’s effects can linger for nearly 36 hours. Your general health and other factors will affect these time estimates.
- If you don’t get the results you want from one PDE5 inhibitor, a different one may be a better match.
- ED medications don’t cause erections. Sexual stimulation is still required to become aroused.
- As you get older, you may require more stimulation to become aroused than you did when you were younger.
- An erection triggered by a penile injection may occur within 15 minutes, though sexual stimulation may still be required for the medication to work.
- Recovery from inflatable penile prosthesis surgery can take 4 to 6 weeks. This means no sexual activity or great physical exertion should take place during that time. Once you’re free to engage in intercourse, the prosthesis takes only minutes to be inflated.
- Lifestyle changes, such as strategies that boost cardiovascular health and weight management, have also been proven to be effective.
Is it safe?
ED medications can be taken safely with most other medications, though they shouldn’t be used if you take nitrates or alpha-blockers.
The combination of PDE5 inhibitors and these medications could cause a dangerous drop in blood pressure.
People with heart disease or kidney disease should discuss the use of PDE5 inhibitors with their doctor. They may prescribe a lower dose, which may or may not help you achieve the results you want.
Injections pose different risks than oral medications as it may be possible to hit a blood vessel or nerve with the syringe. Also, scarring is possible. It’s best to make the injections in different places each time to reduce scarring.
Implant surgery is generally safe, and the technology is constantly improving. It’s important to find a surgeon who has ample experience with this procedure.
When to see a doctor
You can often chalk up occasional episodes of ED to stress, fatigue, relationship conflicts, or other temporary conditions. They don’t necessarily indicate a problem that needs medical attention.
But frequent problems with ED can point to the need for medical attention, especially if the ED is affecting relationships, self-esteem, and quality of life. Talk with your doctor or a urologist if this is the case for you.
Having that conversation is also important because ED can sometimes be an early symptom of diabetes or cardiovascular disease. Your doctor may want to order blood tests and other screenings to check for these underlying conditions.
The bottom line
ED at any age can be a troubling condition. Among older adults, it may be more expected, but it’s nevertheless still a concern.
ED medications and other treatments have a track record of effectively and safely treating ED symptoms in older adults.
Proper treatment starts with a frank conversation with your doctor. Don’t be embarrassed to have this conversation. Rest assured your doctor has the same talk with many other people, year in and year out.
It’s also important to talk openly and honestly with your partner. ED is simply a health condition. It should be approached thoughtfully in a straightforward manner, in the same way you would address any other condition, like arthritis or high blood pressure.
Counseling may also be helpful for both you and your partner while you seek the right medical care for this common concern.
Medically reviewed by Joseph Brito III, MD — Written by James Roland on January 13, 2021