Aging and Sexual Function
Aging and sexual function in men
Aging is a natural phenomenon. However the rate of aging and its attendant sequelae vary greatly among different individuals. One of the various problems that are faced by aging men is sexual dysfunction, which is multidimensional as well as multifactorial in origin. The commonest sexual inadequacy experienced by aging men is erectile dysfunction (ED). ED is increasingly being used as a marker for underlying diseases. In a study of 980 men seeking medical help for ED, many of them were found to have undiagnosed Hypertension (18%), Diabetes (16%), BPH (15%), Ischemic heart disease (5%), Carcinoma prostate (4%), Depression (1%). As has been aptly said that the sexual function men changes from “Tri weekly” in young men to “Try weakly” as the age advances. Various etiological reasons can be sited for this shift of the sexual function as enumerated below.
- Organic dysfunction like
A) Arteriogenic dysfunction,
B) Endothelial dysfunction,
C) Neurogenic causes, including post operative , - Late onset hypogonadism
- Associated disorders of lower urinary tract like LUTS, Incontinence
- Drug induced
- As an effect of generalized chronic illness
- Physical frailty like sarcopenia Incapacitating physical illness involving skeletal system, CHF, COPD
- Psychogenic factors
- FSD in the partner
- Lack of partner
- Social factors like A) lack of privacy, B) financial inadequacy to procure treatment of ED etc
Most of the erectile dysfunction encountered in aging males is organic in nature. The Massachusetts Male Ageing Study found that after age adjustment, men with heart disease, diabetes or hypertension are up to four times more likely to develop some degree of ED compared with men who do not suffer from these disorders. It has been estimated that 39% to 64% of male patients with cardiovascular disease suffer from ED. As the age advances, arteriosclerosis sets in the vascular tree and atherosclerosis and other vascular diseases further compound the situation. Any such disease involving the vasculature from aorta to pudendal vessels can cause ED by restricting the blood flow. It has been found that ED is not only more prevalent in patients with Hypertension than in an age matched general population, it is also more severe in those with hypertension than in general population. In men with hypertension, mild ED was found in 7.75%, moderate ED in 15.4% and severe in 45.2%. It has been postulated that the NO-cGMP mediated hemodynamic mechanism of erection and the NO-cGMP mediated pathway of vasodilatation that play a vital role in blood pressure regulation are impaired in both ED and Hypertension.
Endothelial dysfunction is probably the closest link between the cardiovascular disease and ED. Endothelial dysfunction precedes the formation of atherosclerotic plaque and is common in cardiovascular disease and diabetic patients. It has been found that patients with single vessel Ischemic heart disease have firmer erections than those with triple vessel disease, thereby making penis as a barometer of Vascular status. In men with history of MI 44% -64% had ED prior to the diagnosis of the cardiac condition.
The link of ageing and ED is multifaceted and above is only a brief glimpse at one such aspect of apparent physical and the sexual health. It has been well said that “..it is so much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”