Introduction

A man's genitals—the prostate gland, penis, scrotum, and testicles—are responsible for the physical aspect of sexual function. Collectively, these organs are known as the male reproductive system. The prostate gland and the penis have double duty. Because urine passes through them, they are inevitably involved in how the urinary system functions. Thus, problems with the genitals can affect sexual function or, particularly if the prostate gland or penis malfunctions, urination.

Many older men retain the ability to achieve erections, have orgasms, and ejaculate (release semen at orgasm). Nonetheless, aging itself gradually affects sexual function. Erections occur less often, do not last as long, and are less rigid. The penis becomes less sensitive to touch. After orgasm, the penis becomes limp more rapidly, and having another erection takes longer. The volume of fluid ejaculated usually decreases, and ejaculation can occur with little forewarning. Sex drive may decrease, because the level of testosterone (the main male sex hormone) decreases.

Problems with sexual function can result from disorders of the genitals, other disorders, or mental and emotional factors (such as anxiety, fear, or stress). Many sexual problems result from a combination of these factors. Men sometimes feel pressure (from themselves or a partner) to perform well sexually, and they become distressed when they cannot. This feeling is called performance anxiety. Performance anxiety can further reduce a man's ability to enjoy sexual activity.

Benign prostatic hyperplasia, prostatitis, prostate cancer, inguinal hernia, erectile dysfunction (impotence), a decreased sex drive, and ejaculation abnormalities become more common with aging. Except for prostate cancer and, very rarely, benign prostatic hyperplasia, these disorders are not life threatening. However, they can cause distress and threaten a man's self-esteem. Men may find talking about these disorders difficult and embarrassing. They may feel that the subject is off-limits for discussion, even with their doctor. But men should not let these feelings prevent them from talking with a doctor, because many of the disorders can be effectively treated.

See the sidebar Sexual Activity and Heart Disorders.