Reviewed by Mary Lucas, RN
Written by Our Editorial Team
It’s normal for erectile dysfunction, or ED, to become more common with age. In fact, research shows that men in their 40s have a 40 percent chance of experiencing ED, with the prevalence of ED increasing by 10 percent with each additional decade.
Although ED and aging are definitely associated, turning 65 doesn’t need to mean that your sex life has to suffer.
By maintaining the right habits, focusing on healthy living and using science-based medications for ED, it’s possible to get strong erections and maintain an active sex life well into your 60s and 70s.
Below, we’ve explained how and why ED occurs, as well as the specific medical issues and risk factors that may lead to erectile dysfunction.
We’ve also explained what you can do to maintain good sexual health and avoid letting erectile dysfunction affect your sexual performance after 65.
While getting an erection might seem simple, your body goes through a complicated, multi-step process behind the scenes to make each erection possible.
This process starts with stimulation. When you’re sexually aroused, your nervous system sends electrical signals called nerve impulses to the muscles that control blood flow to your penis.
As these muscles relax, blood starts to flow into the corpora cavernosa — a pair of spongy areas of erectile tissue inside your penis.
This extra blood flow causes pressure to build, resulting in a firmer, larger erection.
In order to maintain your erection, a fibrous membrane called the tunica albuginea tightens and traps blood inside your penis.
As you reach orgasm and ejaculate, the tunica albuginea relaxes and the process reverses, with blood flowing out from the corpora cavernosa and your erection gradually going away.
Erectile dysfunction occurs when one or several things disrupts this process and stops you from being able to get or maintain an erection.
ED is often caused by diseases and health conditions, many of which are more common in men above the age of sixty-five. Diseases and conditions that can cause or contribute to ED include:
Types 2 diabetes
Chronic kidney disease
Atherosclerosis (clogged arteries)
Hypertension (high blood pressure)
Physical injuries that affect the penis, prostate, pelvis, bladder or spinal cord
Complications from surgical procedures, such as surgery for bladder or prostate cancer
Some medications can affect your nervous system, your level of interest in sex or the blood flow to your penis, potentially causing erectile dysfunction. These include:
Medications used to treat high blood pressure
Antiandrogens (medications that affect testosterone and other androgen hormone levels)
Prescription tranquilizers (medications used to treat anxiety or promote sleep)
Medications used to treat gastric, peptic and or duodenal ulcers
Certain habits, behaviors and lifestyle factors can contribute to an increased risk of developing erectile dysfunction. These include:
Drinking lots of alcohol
Being overweight or obese
Living a sedentary lifestyle with limited physical activity
Using illicit drugs or having a substance use disorder
Erectile dysfunction isn’t just physical — in many cases, it’s linked to psychological or emotional issues. The following psychological issues may cause or contribute to ED:
Chronic or severe stress
Fear of sexual failure or sexual performance anxiety
Guilt about having sex or engaging in certain types of sexual activity
Our guide to the causes of erectile dysfunction discusses these factors and the impact they can have on your sexual health and performance in more detail.
Like many health issues, ED becomes much more common with age. However, with a proactive approach, it’s possible to maintain good sexual health and erections well into your 60s, 70s and beyond.
Below, we’ve listed actionable, science-based approaches that you can use to deal with ED and enjoy healthy sexual function after age 65.
One of the most effective ways to treat erectile dysfunction and maintain good sexual function is to use ED medication.
Currently, the FDA has approved four medications for ED. These medications are referred to as PDE5 inhibitors, and they work by increasing the level of blood that can flow to your penis when you feel sexually aroused.
Common ED medications include:
Vardenafil. The active ingredient in Levitra®, vardenafil typically provides relief from ED for four to six hours per dose.
Avanafil. Sold as Stendra®, avanafil is a second-generation ED medication that’s fast to work and less likely to cause certain side effects than other ED drugs.
We offer several ED medications online, following a consultation with a healthcare provider who will determine if a prescription is appropriate.
Medication for ED works quickly and usually produces improvements within 30 to 60 minutes. If you’re one of the tens of millions of men prone to ED, taking a tablet before sex is a convenient, simple way to improve your erections and sexual performance.
Our guide to what you should expect from ED medication goes into more detail about how these drugs work, as well as side effects and interactions that you should know about.
As we mentioned above, ED sometimes occurs due to issues like heart disease, high blood pressure or as a side effect of certain prescription drugs.
Many of these issues become more common with age. For example, people 65 and older have a significantly higher risk of developing coronary heart disease, heart failure and other physical health problems that can cause or contribute to ED.
If you have an underlying health issue that could cause erectile dysfunction, it’s important to talk to your healthcare provider about it.
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ED is often psychological, with mental health issues such as depression, anxiety and even guilt about having sex potentially contributing to weak erections or poor sexual performance.
If you’ve experienced depression symptoms or other signs of a potential mental health issue at the same time as ED, you may want to get in touch with a psychiatrist, psychotherapist or other mental health provider for advice and assistance.
When ED is psychological, options such as cognitive behavioral therapy (CBT) and sex therapy can often help.
Smoking can have a serious negative impact on your sexual performance, causing a range of issues that often includes ED.
As we’ve covered in our guide to smoking and erectile dysfunction, the main culprit behind the negative effects of smoking on your sexual health is nicotine.
As a vasoconstrictor (a chemical that constricts blood vessels), nicotine can make your arteries smaller and reduce blood flow.
This means that less blood can flow to your penis when you’re sexually aroused, making it harder to get and maintain an erection.
Researchers have found that the severity of ED in men who smoke correlates with their level of smoking. Put simply, the more you smoke, the more severe the negative effects of nicotine on your sexual performance appear to be.
If you smoke, try to quit. Not only can quitting improve your sexual performance and reduce the severity of ED — it also offers countless other health benefits, including better heart health and a reduced risk of developing several forms of cancer.
Low testosterone production, or low-T, is a common age-related issue that can affect your sex drive, physical strength and even your sperm count.
Since testosterone levels tend to decline with age, it’s best to talk to your healthcare provider if you’re in your 50s or 60s and have started to develop ED at the same time as other symptoms of low testosterone.
If your testosterone levels are below the normal range, your healthcare provider may prescribe testosterone replacement therapy (TRT).
TRT is effective, but it can have certain disadvantages. We’ve discussed the benefits, risks and other details of TRT in our guide to testosterone replacement therapy.
It’s often possible to prevent ED and improve your sexual performance by making changes to your habits and lifestyle. Try to:
Maintain a healthy weight. Research into the relationship between weight and ED has found that being overweight or obese could increase your risk of erectile dysfunction by 30 to 90 percent compared to people of normal weight. If you’re currently overweight or obese, try to bring your body mass index (BMI) down to the Normal or Healthy Weight range (between 18.5 and 24.9).
Limit your alcohol consumption. Although it’s alright to have a drink or two every now and then, consuming lots of alcohol on a regular basis can affect your sexual health and cause alcohol-induced erectile dysfunction. Try to follow the 2020 Dietary Guidelines for Americans, which recommend limiting your alcohol intake to two alcoholic drinks or less per day.
Get at least seven hours of sleep a night. Research shows that insomnia, obstructive sleep apnea and other conditions that affect your sleep cycle can contribute to a number of health issues, including sexual dysfunction. The CDC recommends getting seven to eight hours of sleep if you’re 65 years of age or older.
Make exercising a habit. Regular exercise improves your cardiovascular health, lowers your blood pressure, helps you to control your weight, enhances your mental health and offers countless other health and wellbeing benefits. It also improves blood flow to your penis. For optimal physical health, try to get at least 150 minutes of moderate-intensity exercise (for example, brisk walking or riding a bicycle around your neighborhood), as well as two strength-focused workouts, every week.
Although issues like erectile dysfunction become more common with age, growing older doesn’t mean that you’ll lose the ability to perform sexually.
By maintaining good habits and, if necessary, using ED medication, you can enjoy a healthy sex life and good erectile function well beyond the age of 65.