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Erectile dysfunction is defined as a consistent inability to obtain or sustain an erection sufficient for intercourse in at least 50% of attempts. The term erectile dysfunction has replaced the more pejorative term impotence. A revolution over the past 10 years in the understanding, diagnosis, and treatment of this disorder has enhanced the ability to discuss it more openly than ever before, by both patients and physicians. This disorder affects 10 million to 30 million men in the United States and more than 140 million men worldwide. 12,33 In 1996, there were 1.3 million office visits for the treatment of erectile dysfunction, reported by the National Ambulatory Medical Care Survey, more than double the rate found in 1985. 7,32 There are few disorders that impact quality of life, sense of self and esteem, and relationships with significant others in quite the same way. Although erectile dysfunction is discussed more openly, many myths remain. With aging, the prevalence of erectile dysfunction increases. This prevalence does not represent normal aging, however, any more than hypertension is considered to be normal in an older adult, and erectile dysfunction is not an inevitable effect of aging. Further, a decline in sexual function may relate to matters other than erectile difficulties, such as illness on the part of an individual or his partner, lack of a partner, loss of libido, or environmental issues (e.g., institutional living).

Impotence occurs commonly with advancing age. Approximately one half of impotent males over 50 years of age have a vascular cause for their impotence. Vascular impotence is often the harbinger of vascular disease in other organs of the body. Hypogonadism occurs in up to one fourth of older men. The relationship of hypogonadism to impotence is uncertain. Medications and neurologic diseases (both central and peripheral) are other major causes of impotence. The treatment of impotence has been revolutionized with the widespread availability of vacuum tumescent devices. The alterations in female sexuality with advancing age have been less well studied. Hysterectomies and bilateral oophorectomies are most probably done more often than necessary in the United States and may alter sexuality. There is some evidence supporting a role for estrogens and testosterone in the regulation of female libido. Physicians need to be more aware of the rapid changes in our understanding of human sexuality and aging.