Sexual function with advancing age.

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.