Erectile Dysfunction After 60: What's Normal, What's Not, and How to Talk to Your Doctor

He goes to bed an hour after her now, every night. She thinks he's lost interest in her. The truth is he's scared it won't work again, and he'd rather avoid the moment than fail at it.

Erection problems are one of the most common health issues men face as they get older, and one of the least talked about. Arousal changes affect women too. The good news: most causes can be treated, and simply understanding what's normal takes a lot of the fear out of it.

How common is it?

Very. The landmark Massachusetts Male Aging Study found that some degree of erectile dysfunction (ED) affected about half of men aged 40 to 70, and the likelihood rises with each decade. By the 70s, it's the majority. So if you searched "erectile dysfunction age 60" or "age 75", you're in very large company.

What's a normal change, and what's ED?

With age, it's normal for erections to:

• take longer to happen,
• need more direct physical touch rather than thoughts alone,
• be a bit less firm,
• and take longer to return afterwards.

ED means having trouble getting or keeping an erection firm enough for sex most of the time, over several months. An occasional off night is not ED. Tiredness, alcohol and stress affect everyone.

Why it's worth seeing a doctor: your heart

The penis has small blood vessels, so circulation problems often show up there first. According to the Mayo Clinic and the NHS, ED can be an early warning sign of heart disease, high blood pressure, diabetes or high cholesterol, sometimes years before other symptoms. That alone makes it worth a check-up.

Other common causes include:

• medications (some blood pressure drugs, antidepressants, prostate drugs),
• prostate surgery or radiation,
• smoking and heavy drinking,
• low testosterone (less common than adverts suggest),
• depression, anxiety and relationship stress.

Treatments that work

A doctor will usually start with lifestyle and medication review, then may suggest:

• PDE5 inhibitor tablets such as sildenafil or tadalafil. These are effective for many men but are not safe with nitrate heart medicines, so they must be prescribed after a proper check.
• Vacuum erection devices, which are drug-free and work for many older men.
• Injections or urethral medication, prescribed by specialists.
• Penile implants for some men when other options haven't worked.
• Counseling or sex therapy, especially when anxiety is part of the picture.

Avoid "herbal Viagra" products sold online. Regulators like the FDA have repeatedly found hidden prescription drugs in them, which can be dangerous for people with heart conditions.

How to bring it up with your doctor

Many men wait years because they don't know how to start. Doctors hear this every day. Try one of these openers:

• "I've noticed some changes with erections and I'd like to check it isn't something to do with my heart."
• "Since starting this medication, things in the bedroom have changed. Could it be related?"
• "This is a bit awkward, but my wife and I have been having trouble with intimacy."

Write it down if that's easier and hand the note over. Bring your medication list.

Arousal changes for women

Women also notice slower arousal with age, along with dryness and sometimes pain after menopause. Lubricants, vaginal moisturizers and, where suitable, prescribed low-dose vaginal estrogen help many women. Our guide to intimacy after menopause covers this in depth.

For partners

If your partner is struggling, it's very unlikely to be about how attractive they find you. Pressure makes ED worse. Try saying: "I miss being close to you, and I don't care whether everything works perfectly." Take sex off the table for a while if needed and focus on touch, kissing and closeness. Many couples find this lowers anxiety enough that things improve.

The bottom line

Slower, softer erections are a normal part of ageing. Consistent problems deserve a doctor's visit, partly because they may point to your heart's health. Treatment works for most men, and the conversation is far less awkward than the silence.

Sources

• Mayo Clinic, "Erectile dysfunction: Symptoms and causes" (mayoclinic.org)
• NHS, "Erectile dysfunction (impotence)" (nhs.uk)
• Feldman HA et al., "Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study", Journal of Urology (1994)
• U.S. FDA, "Tainted sexual enhancement products" (fda.gov)
• National Institute on Aging, "Sexuality and Intimacy in Older Adults" (nia.nih.gov)

This article is for general education and is not a substitute for medical advice.