Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity

doi:10.1016/S0090-4295(00)01091-8

Urology

Volume 57, Issue 4, April 2001, Pages 763-768

https://doi.org/10.1016/S0090-4295(00)01091-8 Get rights and content

Abstract

Objectives. To determine the prevalence rates of erectile and ejaculatory dysfunction, associated bother, and their relation to sexual activity in a population-based sample of elderly men.

Methods. Data were collected from 1688 men by way of self-administered questionnaires (including the International Continence Society male sex questionnaire) and measurements at a health center and urology outpatient department.

Results. The prevalence of significant erectile dysfunction (ie, erections of severely reduced rigidity or no erections) increased from 3% in men 50 to 54 years old to 26% in men 70 to 78 years old. In the same age strata, the prevalence of significant ejaculatory dysfunction (ie, ejaculations with significantly reduced volume or no ejaculations) increased from 3% to 35%. Pain or discomfort during ejaculation was rare (1%) and independent of age. In general, men were more concerned about erectile dysfunction than about ejaculatory dysfunction. However, most men had no or only little concern about their dysfunction. The percentage of men who reported being sexually active declined with increasing age and was lower in men with erectile and ejaculatory dysfunction and in men without a partner. In sexually active men, 17% to 28% had no normal erections, indicating that with advancing age normal erections are not an absolute prerequisite for a sexually active life.

Conclusions. Erectile and ejaculatory dysfunction are common in elderly men. The results of this study indicate that these conditions are much less of a problem for older men than previously suggested.

Section snippets

Material and methods

The data presented were collected as part of a large, ongoing community-based study, the Krimpen study on male urogenital tract problems and general health status, described in detail elsewhere.9 In brief, the Krimpen study investigated all men, 50 to 75 years old (n = 3924), in a Dutch municipality near Rotterdam to gain information on male urogenital tract dysfunction. Men without radical prostatectomy, prostate or bladder cancer, neurogenic bladder disease, or negative advice from their

Results

In the total study population, 93.4% of the men were married or living together.

Comment

The results of this community-based survey indicate that ED and EjD are common in men 50 to 78 years old. However, most men have a low level of concern about their dysfunction.

The response rate of 50% in this study was remarkably high, considering the effort required from the participants and the number of invasive tests performed. Previous population-based studies on this subject achieved similar or lower response rates.2, 3, 5 Higher rates were achieved only in questionnaire-based studies in

Conclusions

The results of this study show that minor degrees of ED and EjD are common in Dutch men 50 to 78 years old. Significant ED and EjD are less common. However, the level of associated concern is rather low; this may indicate that most men consider this part of the aging process. Men have more concern about ED than about EjD. Pain or discomfort during ejaculation is a rare but concern-provoking problem in these men.

Additional studies are needed to determine how these figures relate to doctors’

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Cited by (200)

Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer
2022, Journal of Sexual Medicine
Citation Excerpt :
Patients eligible for this study were those who had histologically confirmed prostate cancer and were capable of ejaculating at the time of initial consultation (answered yes on question 1 of the Ejaculation Scale [ES-8]) (Figure S2). Patients who were greater than 70 years old or received androgen deprivation therapy (ADT) were excluded from this study due to their known adverse effects on ejaculation.2,16 Patients treated from 2013 to 2019 were included.
Ejaculatory dysfunction is an important male quality of life issue which has not yet been studied in the setting of prostate stereotactic body radiation therapy (SBRT).
The purpose of this study is to evaluate ejaculatory function following SBRT for prostate cancer.
Two hundred and thirty-one patients on a prospective quality of life study with baseline ejaculatory capacity treated with prostate SBRT from 2013 to 2019 were included in this analysis. Ejaculation was assessed via the Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire. Patients completed the questionnaire at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from analysis. Patients were treated to 35–36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray).
Ejaculatory function was assessed by ES-8 scores (range 4–40) with lower values representing increased interference or annoyance.
Median age at the time of treatment was 65 years. Median follow up was 24 months (IQR 19–24.5 months). 64.5% of patients had ED at baseline (SHIM < 22). The 2-year anejaculation rate was 15%. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.4 (start of treatment); 26.5 (1 month); 27.6 (3 month); 27.0 (6 month); 26.2 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.4 (24 month). White race, higher pre-treatment SHIM (≥22), and higher ES-8 (≥31) at treatment start were significantly associated with a decreased probability of a clinically significant decline. Patient-reported ejaculate volume was significantly reduced at all time points post-SBRT. Ejaculatory discomfort peaked at 1 month and 9 months post-SBRT. Prior to treatment, 8.0% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. The number of patients reporting this concern increased to 14.4% at one year and dropped to 11% at 24-months post-SBRT.
Patients undergoing prostate SBRT may experience meaningful changes in ejaculatory function and should be counseled on the trajectory of these side effects.
This was a retrospective analysis of a prospectively maintained database. Subjective questionnaire responses captured limited aspects of ejaculatory function in this cohort.
The high incidence of moderate to extreme bother in ejaculatory function before and after SBRT suggests a need for novel approaches to improving ejaculation.
Sholklapper T, Creswell M, Cantalino J, et al. Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer. J Sex Med 2022;19:771–780.
Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia
2021, Sexual Medicine
Erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are known outcomes of traditional surgery and some pharmacotherapies for treatment of benign prostatic hyperplasia (BPH). Minimally invasive treatment options, including water vapor thermal therapy (WVTT), are now available to treat lower urinary tract symptoms (LUTS) due to BPH.
The objective of this analysis was to evaluate long-term impact of a single water vapor thermal therapy procedure on erectile and ejaculatory function in subjects enrolled in the Rezum II prospective, multicenter, randomized, blinded controlled trial.
Fifteen centers enrolled 197 subjects with International Prostate Symptom Score (IPSS) ≥ 13, maximum flow rate (Qmax) ≤ 15 mL/s, and prostate volume 30–80 cc. Subjects were randomized (2:1) to (WVTT) or sham procedure (control) and followed for 5 years. Erectile and ejaculatory functions were quantitatively assessed at baseline and yearly thereafter. After 3 months, control subjects could opt to requalify for cross-over to WVTT and were followed for 5 years. Results of the per protocol analysis were reported previously. The current post hoc analysis was performed on all treated subjects who were sexually active at baseline with no other surgical or medical management for BPH during the 5-year study period.
LUTS was evaluated using IPSS, Benign Prostatic Hyperplasia Impact Index (BPHII), and Qmax. Sexual function was assessed using the International Index of Erectile Function (IIEF-EF) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD).
A total of 197 subjects (136 treated, 61 control) were enrolled in the study, and 53 control subjects opted to cross-over and receive WVTT. All subgroups experienced significant, durable improvement in IPSS (P < .0001). Subjects with normal sexual function at baseline had little change in function over 5 years (IIEF-EF: −2.4 ± 8.9, P = .1414; MSHQ-EjD Function: −1.6 ± 3.2, P = .0083; MSHQ-EjD Bother: −0.5 ± 1.6, P = .1107). Subjects with baseline medical history of ED and EjD showed slight decline over time that was not clinically significant (ED, IIEF-EF: −3.0 ± 10.1, P = .1259; MSHQ EjD Function: −2.3 ± 4.7, P = .0158; MSHQ-EjD Bother: −0.1 ± 2.6, P = .7764; EjD, IIEF-EF: −4.1 ± 9.2, P = .0127; MSHQ EjD Function: −1.6 ± 4.8, P = .1970; MSHQ-EjD Bother: −0.4 ± 2.6, P = .440).
Treatment for BPH with Rezum durably improved IPSS without clinically significant impact on sexual function. Patients with baseline ED/EjD may expect continued decline from other causes but are unimpacted by the therapy.
The results are limited by the post-hoc nature of the analysis and attrition over the 5-year follow-up but provide long-term evidence of durable outcomes after treatment with Rezum without impact on sexual function scores. McVary KT, El-Arabi A, Roehrborn C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sex Med 2021;9:100454.
Cross-Sectional Study of Sexual Activity and Satisfaction Among Older Adult's ≥60 Years of Age
2021, Sexual Medicine
Despite the rapidly increasing population of older adults, little is currently known about sexual activity and sexual satisfaction among the oldest people.
The present study aimed to investigate sexual activity and sexual satisfaction among people of ≥60 years of age. We also examined whether sexual activity and sexual satisfaction were influenced by age, gender, cohabiting, socioeconomic factors, education, functional ability, and self-reported health.
We performed a descriptive analysis of self-stated sexual activity and sexual satisfaction among 1680 participants who were 60 years and older from the Swedish National Study on Aging and Care. Chi-square tests and logistic regression were used to analyze relationships between factors.
Sexual activity and sexual satisfaction.
Among participants aged ≥90 years, about 10% were sexually active. Within the total study population, 46% (654/1680) were sexually active. Overall, sexually activity was more commonly reported by men (55%) than women (40%). However, men in all age cohorts reported sexual dissatisfaction more commonly than women. In the total sample, 24% (246/1680) reported dissatisfaction with their sex life. Sexual activity and sexual satisfaction were positively associated with self-reported health and cohabitation.
The present results suggest that sexual activity is present throughout life. For persons older than 90 years, about 10% of participants were sexually active, regardless of gender. Every third man reported dissatisfaction with his sex life. Women were more satisfied with their sex lives than men, and this difference varies more widely among age cohorts. These findings confirm that it is important that health professional take sexuality into account during caring encounters with older persons.
M Stentagg, L Skär, JS Berglund, et al. Cross-Sectional Study of Sexual Activity and Satisfaction Among Older Adult's ≥60 Years of Age. Sex Med 2021;9:100316.
Sexual Dysfunction and Bother Due to Erectile Dysfunction in the Healthy Elderly Male Population: Prevalence from a Systematic Review
2020, European Urology Focus
Citation Excerpt :
Seventeen studies investigated the impact of bother due to ED for men aged 60 yr and older [4,15–17,22,25,29,31,34,42,44,45,52,54,56,65,74]. The percentage of men above 60 yr of age who were bothered by ED spread widely from 6.7% to 70% [17,22,25,29,31,52,54,74]. All studies, however, showed an overall decrease in being bothered by ED in relation to an increase in age.
Therapies initiated by urologists, medical as well as surgical, may cause adverse effects in different sexual domains. Sexual domains that are often affected are sexual interest, sexual activity, and erectile functioning. As many elderly men undergo these therapies, it is important to know the prevalence of sexual dysfunction (SD) in these domains and its impact in the healthy elderly male population. This may help healthcare providers counsel their patients properly on possible adverse effects.
To review the prevalence of sexual functioning and SD in the domains of sexual desire, sexual activity, and erectile dysfunction (ED) and its impact (bother and medical use), stratified by age.
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Studies investigating the prevalence of SD, stratified by age, were eligible. Studies investigating bother due to ED, and studies evaluating medical use or use of medical professional healthcare providers in association with SD were eligible.
A total of 76 articles were eligible for a full systematic review. Lack of sexual desire was reported to vary between 12% and 51.6% for men aged ≥60 yr, 20% and 65.9% for men aged ≥70 yr, and 40% and 82.4% for men aged ≥80 yr. The percentages of men bothered by ED were as follows: 14.3–70% for men aged ≥60 yr, 6.7–48% for men aged ≥70 yr, and 38% for men aged ≥80 yr. A substantial number of men (50.3–92%) find a normal sex life important as they age and remain sexually active. Only a minority of elderly men seek help from healthcare professionals or use medication for SD.
The prevalence of SD in the healthy male population, reflected by a loss of sexual desire and sexual activity, increases only slightly with age. Bother due to ED is relatively low and there is an association with age. Still, a large number of men in the middle-aged and elderly groups regard sexuality as an important aspect of life. While considering a surgical or medical therapy that could have an impact on sexual functioning, sexually related outcomes should be set against current sexual functioning and a probable decline of sexual functioning due to ageing.
While counselling elderly patients for sexual dysfunction when starting a treatment that could have an influence on sexual functioning, one should consider current sexual functioning and its importance for the individual.
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2019, Encyclopedia of Pharmacy Practice and Clinical Pharmacy: Volumes 1-3
The term disease mongering appears to have been coined back in the early 1990s by the medical journalist Lynn Payer and popularized in a conference in Newcastle Australia in 2006. Disease mongering is defined as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.” Companies monger diseases to both health care professionals and consumers through a variety of methods, including use of key opinion leaders, clinical practice guidelines, continuing medical education, ghost management, direct-to-consumer advertising, funding patient groups, and the use of mass media. This article uses four examples—erectile dysfunction, social anxiety, overactive bladder, and osteoporosis—to show how these methods are applied in practice.
Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels
2017, Journal of Sexual Medicine
Although delayed ejaculation (DE) is typically characterized as a persistently longer than anticipated or desired time to ejaculation (or orgasm) during sexual activity, a timing-based definition of DE and its association with serum testosterone has not been established in a large cohort.
To examine in an observational study estimated intravaginal ejaculatory latency time (IELT) and masturbatory ejaculation latency time (MELT) in men self-reporting DE, assess the association of IELT and MELT with serum testosterone levels, and determine whether correlation with demographic and sexual parameters exist.
Men who resided in the United States, Canada, and Mexico were enrolled from 2011 to 2013. Self-estimated IELT and MELT were captured using an Ejaculatory Function Screening Questionnaire in a sample of 988 men screened for possible inclusion in a randomized clinical trial assessing testosterone replacement therapy for ejaculatory dysfunction (EjD) and who self-reported the presence or absence of DE and symptoms of hypogonadism. Additional comorbid EjDs (ie, anejaculation, perceived decrease in ejaculate volume, and decreased force of ejaculation) were recorded. Men with premature ejaculation were excluded from this analysis. IELT and MELT were compared between men self-reporting DE and men without DE. The associations of IELT and MELT with serum testosterone were measured.
IELT, MELT, and total testosterone levels.
Sixty-two percent of screened men self-reported DE with or without comorbid EjDs; 38% did not report DE but did report at least one of the other EjDs. Estimated median IELTs were 20.0 minutes for DE vs 15 minutes for no DE (P < .001). Estimated median MELTs were 15.0 minutes for DE vs 8.0 minutes for no DE (P < .001). Ejaculation time was not associated with serum testosterone levels. Younger men and those with less severe erectile dysfunction had longer IELTs and MELTs.
Estimated ejaculation times during vaginal intercourse and/or masturbation were not associated with serum testosterone levels in this study; thus, routine androgen evaluation is not indicated in these men.
This large systematic analysis attempted to objectively assess the ejaculation latency in men with self-reported DE. Limitations were that ejaculation time estimates were self-reported and were queried only once; the questionnaire did not distinguish between failure to achieve orgasm and ejaculation; and assessment of DE was limited to heterosexual vaginal intercourse and masturbation.
IELT and MELT were longer in men with DE, and there was no association of ejaculation times with serum testosterone levels in this study population.
Morgentaler A, Polzer P, Althof S, et al. Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels. J Sex Med 2017;14:1116–1124.

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^☆: This study was supported by the Foundation for Urologic Research Rotterdam, Rotterdam, The Netherlands.

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Adult urologyErectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity☆