Vascular aging-driven erectile dysfunction: pathophysiological mechanisms and emerging therapies-a narrative review

Area of Science:

• Gerontology
• Vascular Biology
• Urology

Background:

• Age-related erectile dysfunction (ED) is a significant health concern linked to vascular aging, characterized by endothelial dysfunction and vascular smooth muscle alterations.
• ED in elderly men is associated with systemic vascular pathology, acting as an early warning signal for overall vascular health.

Purpose of the Study:

• To explore the pathophysiological mechanisms of age-related ED in elderly men.
• To provide new directions for the diagnosis and development of novel targeted therapies for age-related ED.

Main Methods:

• A comprehensive literature review from 2000 to 2025 was conducted.
• Searches included PubMed, Web of Science, and Embase using keywords related to erectile dysfunction, aging, vascular endothelium, and vascular smooth muscle.
• Prioritization was given to high-quality clinical and preclinical studies on pathophysiology or novel treatments.

Main Results:

• Key contributors to age-related ED include reduced nitric oxide bioavailability, endothelial oxidative stress, inflammation, diminished smooth muscle content, and increased arterial stiffness.
• Metabolic disorders, chronic inflammation, oxidative stress, and hormonal imbalances accelerate vascular aging, making ED an early indicator of systemic vascular pathology.
• Current treatments like PDE5 inhibitors and testosterone offer symptomatic relief but have limitations; emerging interventions are experimental.

Conclusions:

• Age-related ED is a manifestation of systemic vascular pathology and an early warning signal for vascular health.
• Current treatments for ED have limitations, highlighting the need for advanced therapeutic strategies.
• Promising future directions include enhancing endothelial NO synthase function, stem-cell therapy, and nanotechnology for ED treatment.