Sexual health for the man at midlife: in-office workup

Normal physiologic changes occur with age that affect male sexuality. The etiology of these problems is often vascular but may be influenced by medications, neurologic conditions, or endocrinopathies, and/or iatrogenic factors. Penile sensitivity and erectile responses decline with age, and patients may present with concerns about ejaculatory disorders and erectile dysfunction. Physicians need to know the pharmacologic, surgical, and educational solutions. Treatment modalities for erectile dysfunction include vacuum erection, devices, intracavernosal or intraurethral alprostadi injections, and penile implants.