What medical treatments and behavioral interventions are effective for erectile and orgasmic problems in men over 75?
Executive summary
Men over 75 with erectile problems most often benefit from a stepwise approach that begins with evaluation and risk-factor management, uses phosphodiesterase‑5 (PDE5) inhibitors as first‑line medical therapy when safe, and employs device, hormonal, and psychosexual strategies when medicines fail; orgasmic and ejaculatory dysfunctions are common but less well‑studied, with fewer evidence‑based treatments available [1] [2] [3]. Lifestyle modification, treating comorbidities, and couples or behavioral therapy are critical adjuncts and sometimes the most durable interventions for restoring sexual function and satisfaction [4] [5] [6].
1. Comprehensive assessment first: look past the symptom
A careful medical history, medication review and targeted testing should precede treatment because ED in older men is frequently multifactorial—cardiovascular disease, diabetes, polypharmacy, hormonal deficits and neurologic injury all contribute—so diagnosing reversible causes both directs therapy and uncovers other illnesses [1] [7] [8].
2. PDE5 inhibitors remain the frontline medical option
Oral PDE5 inhibitors such as sildenafil, tadalafil and vardenafil are effective and generally the initial pharmacologic choice in older men, with studies showing efficacy across age groups and in patients with many common comorbidities; dosing and selection should be individualized for tolerability and interactions [2] [9] [10].
3. Safety and contraindications must guide prescribing
While PDE5 inhibitors are safe for many older men—including those with coronary artery disease in several studies—these drugs interact dangerously with nitrates and require cardiovascular assessment before use, making clinician oversight essential in this age group [7] [11].
4. Devices and second‑line medical therapies when pills aren’t enough
Vacuum erection devices and lower‑dose or tailored medication regimens are viable alternatives or adjuncts for men who cannot take PDE5 inhibitors or for whom pills are insufficient; surgical implants or intracavernosal injections are recognized second‑line options but demand specialist evaluation and informed consent given risks and maintenance needs [5] [7].
5. Hormone therapy is targeted, not universal
When biochemical testing confirms low testosterone, replacement can improve desire and sometimes erectile function, but it is not a universal cure and must be offered after discussion of benefits, monitoring needs, and potential risks in older men [5] [2].
6. Behavioral and lifestyle interventions move the needle
Modifiable factors—smoking cessation, weight loss, regular physical activity, optimizing blood pressure and glucose control—meaningfully improve erectile function or the response to medical treatment and should be part of any management plan for seniors [4] [12].
7. Psychosexual and couples therapy address the non‑physical barriers
Psychological contributors and relationship factors frequently sustain or worsen sexual dysfunction in older men; counseling, sex therapy, and couples work improve outcomes and are recommended alongside medical measures, particularly when orgasmic or ejaculatory complaints coexist [6] [3].
8. Orgasmic and ejaculatory dysfunction: an evidence gap
Orgasmic problems—delayed orgasm, anorgasmia, reduced pleasure—and ejaculatory disorders are common in aging men but are less well researched; current strategies largely focus on treating underlying medical causes and addressing erectile dysfunction or psychological contributors, with limited high‑quality evidence for targeted pharmacologic cures [3] [9].
9. Real‑world context and commercial messaging
Many consumer and clinic sites promote pills, “cutting‑edge” procedures, or hormone programs—options that can help but sometimes reflect commercial incentives—so clinical decisions should prioritize peer‑reviewed evidence and individualized risk assessment rather than marketing [13] [10] [6].
10. Practical takeaway: combine approaches under medical guidance
For men over 75 the most effective strategy is a combined one—diagnostic evaluation, optimization of health and medications, lifestyle change, first‑line PDE5 therapy when appropriate, device or specialist interventions if needed, and psychosexual support—while acknowledging that orgasmic dysfunction remains a harder-to‑treat domain with limited data [1] [4] [2] [3].