What lifestyle changes and treatments improve sexual function and orgasm in older men?

1. Lifestyle: the high-return basics that actually move the needle

Improving cardiovascular and metabolic health is the single most consistent strategy to preserve erections and improve sexual responsiveness: regular aerobic exercise, maintaining a healthy weight and a plant‑rich diet reduce vascular risk factors (hypertension, diabetes, high cholesterol) that underlie erectile problems ^{[2] [4]}; quitting smoking restores nitric‑oxide mediated blood flow and improves penile vascular function ^[1], and cutting excessive alcohol likewise helps ^[5]. Multiple clinical and institutional reviews emphasize that lifestyle change can prevent progression of erectile dysfunction and, in many cases, measurably improve sexual function without immediate drugs ^{[1] [6] [7]}.

2. First-line medications and the controversies around hormones

Phosphodiesterase‑5 inhibitors (Viagra®, Cialis®, Levitra®) are widely recommended first‑line for erectile dysfunction and remain effective for many older men, though dosing and cardiovascular risk must be individualized ^{[2] [7]}. Testosterone replacement can substantially boost libido in men with documented low testosterone, but its role in treating orgasmic or ejaculatory problems is controversial and evidence in older populations is limited; guidelines call for careful testing, counselling and monitoring if used ^{[8] [3] [7]}. Clinical reviews caution that orgasmic and ejaculatory dysfunctions are often multifactorial—vasculogenic or neurogenic causes can be irreversible—so realistic expectations and reassessment are essential ^[3].

3. Devices, injections and emerging procedural options

When pills fail or are contraindicated, effective device and procedural options exist: vacuum erection devices and intracavernosal injections (ICI/Trimix) can produce reliable erections even after surgery or in complex medical cases ^{[9] [10]}. Some clinics promote low‑intensity shockwave or “sound wave” therapy to improve penile blood flow and nerve function; while promising in certain studies, these modalities are still evolving and should be considered adjunctive rather than universally curative ^{[11] [7]}.

4. Sensation, orgasmic changes and the role of therapy and technique

Aging commonly brings slower arousal, longer refractory periods and reduced penile sensitivity—all of which change the timing and quality of orgasm ^{[8] [5]}. Behavioral strategies, sex therapy and couples counselling frequently improve outcomes by teaching partners how to maximize stimulation, adapt foreplay and address relationship or psychological contributors; clinicians often combine counseling with urologic treatments for better results ^{[8] [2]}. Pelvic‑floor exercises (Kegels) are cited by some sources as potentially helpful to strengthen orgasmic response and sensation, though evidence quality varies and more research is needed ^[12].

5. A practical roadmap and realistic expectations

Begin with a medical workup to identify reversible contributors (cardiometabolic disease, medications, prostate treatment effects), then prioritize lifestyle changes—exercise, weight loss, stop smoking, moderate alcohol—and basic psychosexual care ^{[1] [6] [4]}. If problems persist, PDE5i are a proven next step; hormone therapy may help selected men with confirmed hypogonadism but requires monitoring and informed consent ^{[2] [8] [3]}. For refractory cases, referral to urology for devices, ICI or specialist therapies and to sex therapy for technique and relationship work is the accepted pathway ^{[10] [9] [8]}. Importantly, the literature notes gaps—especially limited high‑quality data on treatments specifically for ejaculatory and orgasmic dysfunction in older men—so individualized care and regular reassessment are necessary ^[3].