Patient: 77 male, very sexually active younger, wife ill, then passed. No sex 15 years. Met attractive lady, 77 too. Intense snuggling and petting. Old feelings come back but no erection. Copious cowpers fluid. If we keep trying any hope of a surprise one night. Type 2 diabetes in reversal. Blood pressure and colesterol under control
Doctor: Sexuality is an important component of emotional and physical intimacy that men and women experience through their lives . Male erectile dysfunction (ED) and female sexual dysfunction increase with age. About a third of the elderly population has at least one complaint with their sexual function. However, about 60% of the elderly population expresses their interest for maintaining sexual activity and some of them face problems.In the aging patient, the cause of erectile dysfunction is multifactorial. Masters and Johnson (1977) noted a number of changes in older men including: greater latency to erection, less turgid erections, loss of forceful ejaculation, decreased ejaculatory volume, and a longer refractory period. Other investigators have indicated a decrease in penile tactile sensitivity, a decrease in nitric oxide synthase activity, a heightened cavernous muscle tone, and/or a decrease in testosterone in the elderly patient. The most common causes of organic erectile dysfunction are vascular abnormalities, frequently associated with arteriosclerosis and diabetes mellitus. Others factors include neurologic diseases (Alzheimer’s disease, multiple sclerosis and spinal cord lesions), chronic systemic disorders (renal, hepatic and lung), oncologic diseases and pelvic irradiation. Our laboratory results have shown a decrease of nitric oxide synthase-containing nerves and lower responses to central and peripheral stimulus in old rats. Hypogonadism, as frequently seen in the elderly, is also a risk factor for erectile dysfunction and loss of libido. Researchers have shown in the laboratory that the restoration of erectile response can be achieved with replacement of testosterone or dihydrotestosterone. Pituitary and thyroid diseases can also affect the libido and erection. Drug related ED is estimated to be around 25% in various studies. Antihypertensives, hormones, antidepressants, tranquilizers, alcohol, tobacco, heroin and cocaine have all been associated with ED. One would expect that the elderly patient would be more likely to be taking more medications, which could alter his erectile response.Please visit your doctor for help.