Changes in Male Sexual Function

  • Larry E. Johnson
  • Fran E. Kaiser
  • John E. Morley


Sexual dysfunction is common with advancing age;1–4 frequency of sexual intercourse decreases and erectile dysfunction commonly increases with age. However, decline in sexual function (measured as coital activity) is only indirectly associated with advancing age, is not necessarily inevitable, and varies among individuals. Sexual dysfunction arises from psychologic, physiologic, and pathologic causes within one or more of the following categories5,6: (a) sexual appetite or desire; (b) sexual arousal, including erectile dysfunction; (c) orgasmic, including inhibited orgasm and premature ejaculation; and (d) sexual pain disorders. The first two categories are most commonly seen in older individuals. By age 75, at least 50% of men have developed impotence7 Despite these numbers, sexuality is poorly understood and sexual disorders are frequently underdiagnosed and under-treated in older men.


Erectile Dysfunction Sexual Function Sexual Dysfunction Premature Ejaculation Penile Prosthesis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kaiser FE. Sexuality and impotence in aging men. Clin Geriatr Med. 1991; 7: 63–72.PubMedGoogle Scholar
  2. 2.
    Slag MF, Morley JE, Elson MK, et al. Impotence in medical clinic outpatients. JAMA. 1983; 249: 1736–1740.PubMedCrossRefGoogle Scholar
  3. 3.
    Spector IP, Carey MP. Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature. Arch Sex Behay. 1990; 19: 389–408.CrossRefGoogle Scholar
  4. 4.
    Solstad K, Hertoft P. Frequency of sexual problems and sexual dysfunction in middle-aged Danish men. Arch Sex Behay. 1993; 22: 51–58.CrossRefGoogle Scholar
  5. 5.
    Halvorsen JG, Metz ME. Sexual dysfunction. Part I: classification, etiology and pathogenesis. J Am Board Fam Pract. 1992; 5: 51–61.PubMedGoogle Scholar
  6. 6.
    Halvorsen JG, Metz ME. Sexual dysfunction. Part II: diagnosis, management, and prognosis. J Am Board Fam Pract. 1992; 5: 177–192.PubMedGoogle Scholar
  7. 7.
    Morley JE, Kaiser FE. Impotence: the internist’s approach to diagnosis and treatment. Adv Intern Med. 1993; 38: 15 1168.Google Scholar
  8. 8.
    Kaas MJ. Sexual expression of the elderly in nursing homes. Gerontologist. 1978; 18: 372–378.PubMedCrossRefGoogle Scholar
  9. 9.
    Schiavi RC, Schreiner-Engel P, Mandeli J, et al. Healthy aging and male sexual function. Am J Psychiatry. 1990; 147: 766–771.PubMedGoogle Scholar
  10. 10.
    Schiavi RC. Normal aging and the evaluation of sexual dysfunction. Psychiatric Med. 1992; 10: 217–225.Google Scholar
  11. 11.
    Diokno AC, Brown MB, Herzog AR. Sexual function in the elderly. Arch Intern Med. 1990; 150: 197–200.PubMedCrossRefGoogle Scholar
  12. 12.
    Pfeiffer E, Verwoerdt A, Wang H-S. The natural history of sexual behavior in a biologically advantaged group of aged individuals. J Gerontol. 1969; 24: 193–198.PubMedCrossRefGoogle Scholar
  13. 13.
    Verwoerdt A, Pfeiffer E, Wang H-S. Sexual behavior in senescence. Geriatrics. 1969; 24 (Feb): 137–154.PubMedGoogle Scholar
  14. 14.
    Pfeiffer E, Verwoerdt A, Wang H-S. Sexual behavior in aged men and women. Arch Gen Psychiatry. 1968; 19: 753758.Google Scholar
  15. 15.
    Rowland DL, Greenleaf WJ, Dorfman U, et al. Aging and sexual function in men. Arch Sex Behay. 1993; 22: 545557.Google Scholar
  16. 16.
    Mulligan T, Moss CR. Sexuality and aging in male veterans: a cross-sectional study of interest, ability and activity. Arch Sex Behay. 1991; 20: 17–25.CrossRefGoogle Scholar
  17. 17.
    Kinsey AC, Pomeray WB, Martin 0E. Sexual Behavior in the Human Male. Philadelphia: WB Saunders; 1948.Google Scholar
  18. 18.
    Martin CE. Factors affecting sexual functioning in 60 to 79-year-old married males. Arch Sex Behay. 1981; 10: 399420.Google Scholar
  19. 19.
    Bretschneider JG, McCoy NL. Sexual interest and behavior in healthy 80- to 102-year-olds. Arch Sex Behay. 1988; 17: 109–129.CrossRefGoogle Scholar
  20. 20.
    Persson G, Svanborg A. Marital coital activity in men at the age of 75: relation to somatic, psychiatric, and social factors at the age of 70. J Am Geriatr Soc. 1992; 40: 439–444.PubMedGoogle Scholar
  21. 21.
    Stall R, Catania J. AIDS risk behaviors among late middle-aged and elderly Americans. Arch Intern Med. 1994; 154: 57–63.PubMedCrossRefGoogle Scholar
  22. 22.
    Wasow M, Loeb MB. Sexuality in nursing homes. J Am Geriatr Soc. 1979; 27: 73–79.PubMedGoogle Scholar
  23. 23.
    Mulligan T, Palguta RF. Sexual interest, activity and satisfaction among male nursing home residents. Arch Sex Behay. 1991; 20: 199–204.CrossRefGoogle Scholar
  24. 24.
    Bullard-Poe L, Powell C, Mulligan T. The importance of intimacy to men living in a nursing home. Arch Sex Behay. 1994; 23: 231–236.CrossRefGoogle Scholar
  25. 25.
    Kaiser FE, Morley JE. Sexuality and dementia. In: Morris JC, ed. Handbook of Dementing Illnesses. New York: Marcel Dekker; 1994: 539–548.Google Scholar
  26. 26.
    Neaves WB, Johnson L, Parker CR, Petty CS. Leydig cell numbers, sperm production, and serum gonadotropin levels in aging men. J Clin Endocrinol Metab. 1984; 59: 756763.Google Scholar
  27. 27.
    Davidson JM, Chen JJ, Crapo L, et al. Hormonal changes and sexual function in aging men. J Clin Endocrinol Metab. 1983; 57: 71–77.PubMedCrossRefGoogle Scholar
  28. 28.
    Korenman SG, Morley JE, Mooradian AD, et al. Secondary hypogonadism in older men: its relationship to impotence. J Clin Endocrinol Metab. 1990: 71: 963–969.PubMedCrossRefGoogle Scholar
  29. 29.
    Gray A, Berlin JA, McKinley JB, Loncope C. An examination of research design effects on the association of testosterone and male aging: results of a meta-analysis. J Clin Epidemiol. 1991; 44: 671–684.PubMedCrossRefGoogle Scholar
  30. 30.
    Vermuelen A. Androgens in the aging male. J Clin Endocrinol Metab. 1991; 73: 221–224.CrossRefGoogle Scholar
  31. 31.
    Kley HK, Nieschlag E, Bidlingmaler A, et al. Possible age dependent influence of estrogens on the binding of testosterone in plasma of adult men. Horm Metab Res. 1974; 6: 213–215.PubMedCrossRefGoogle Scholar
  32. 32.
    Vermuelen A, Verdonck L. Some studies on the biological significance of free testosterone. J Steroid Biochem. 1972; 3: 421–426.CrossRefGoogle Scholar
  33. 33.
    Tenover JS, Matsumato AM, Plymate SR, Bremner WJ. The effects of aging in normal men on bioavailable testosterone and luteinizing hormone secretion: response to clomiphene citrate. J Clin Endocrinol Metab. 1987; 65: 1118–1126.PubMedCrossRefGoogle Scholar
  34. 34.
    Kaiser FE, Viosca SP, Morley JE, et al. Impotence and aging: clinical and hormonal factors. J Am Geriatr Soc. 1988; 36: 511–519.PubMedGoogle Scholar
  35. 35.
    Lewis JG, Chanadian R, Chishold GD. Serum 5 alphadihydrotestosterone and testosterone changes with age in men. Acta Endocrinol (Copenh). 1976; 82: 444–449.Google Scholar
  36. 36.
    Pirke KM, Doerr P, Sinterman R, et al. Age dependence of testosterone precursors in plasma of normal adult males. Acta Endocrinol (Copenh). 1977; 86: 415–429.Google Scholar
  37. 37.
    Horton R, Hsieh P, Barberia J, et al. Altered blood androgens in elderly men with prostatic hyperplasia. J Clin Endocrinol Metab. 1975; 41: 793–796.PubMedCrossRefGoogle Scholar
  38. 38.
    Kaiser FE, Morley JE. Gonadotropin, testosterone, and the aging male. Neurobiol Aging. 1994; 15: 559–563.PubMedCrossRefGoogle Scholar
  39. 39.
    Ceccatelli S, Hurting AL, Zhang X, et al. Nitric oxide synthase in the rat anterior pituitary gland and the role of nitric oxide in regulation of luteinizing hormone secretion. Proc Nat Acad Sci USA. 1993; 90: 11292–11296.PubMedCrossRefGoogle Scholar
  40. 40.
    Tenover JS, McLachlan RI, Dahl KD, et al. Decreased serum inhibin levels in normal elderly men: evidence for a decline in Sertoli cell function with aging. J Clin Endocrinol Metab. 1988; 67: 455–459.PubMedCrossRefGoogle Scholar
  41. 41.
    Stanley HL, Schmitt BP, Poses RM, et al. Does hypogonadism contribute to the occurrence of a minimal trauma hip fracture in elderly men? J Am Geriatr Soc. 1991; 39: 766–771.PubMedGoogle Scholar
  42. 42.
    Foresta C, Ruzza G, Mioni R, et al. Osteoporosis and decline of gonadal function in elderly men. Horm Res. 1984; 19: 18–22.PubMedCrossRefGoogle Scholar
  43. 43.
    Tenover JS. Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab. 1992; 75: 1092 1098.Google Scholar
  44. 44.
    Morley JE, Perry HM III, Kaiser FE, et al. Effects of testosterone replacement in old hypogonadal males: a preliminary study. J Am Geriatr Soc. 1993; 43: 149–152.Google Scholar
  45. 45.
    Hobbs CJ, Plymate SR, Rosen CJ, et al. Testosterone administration increases insulin-like growth factor levels in normal men. J Clin Endocrinol Metab. 1993; 77: 776779.Google Scholar
  46. 46.
    Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol. 1994; 151: 54–61.PubMedGoogle Scholar
  47. 47.
    Ackerman MD, D’Attilio JP, Antoni MH, et al. Patient-reported erectile dysfunction: a cross-validation study. Arch Sex Behay. 1993; 22: 603–618.CrossRefGoogle Scholar
  48. 48.
    Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982; 128: 492.PubMedGoogle Scholar
  49. 49.
    Krane RJ, Goldstein I, de Tejada IS. Impotence. N Engl J Med. 1989; 321: 1648–1659.PubMedCrossRefGoogle Scholar
  50. 50.
    Wagner G, Brindley GS. The effect of atropine and Cblockers on human penile erection. In: Zorgniotti AW, Rossi G, eds. Vasculogenic Impotence. Springfield, IL: Charles C. Thomas; 1980: 77–81.Google Scholar
  51. 51.
    Schwartz AN. Radiologic diagnosis and treatment of erectile dysfunction. Curr Opin Radiol. 1992; 4 (II): 39–50.PubMedGoogle Scholar
  52. 52.
    Rajfer J, Aronson WJ, Bush PA, et al. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med. 1992; 326: 90–94.PubMedCrossRefGoogle Scholar
  53. 53.
    Padma Nathan H, Boyd SD, Cheung D. The biochemical effects of aging, diabetes, and ischemia on corporal and tunica collagen. J Urol. 1991; 145: 342A.Google Scholar
  54. 54.
    Masters WH, Johnson VE. Sex and the aging process. J Am Geriatr Soc. 1981; 29: 385–390.PubMedGoogle Scholar
  55. 55.
    Aboseif SR, Lue TF. Hemodynamics of penile erection. Urol Clin North Am. 1988; 15: 1–7.PubMedGoogle Scholar
  56. 56.
    Lue TF. Erectile dysfunction: problems and challenges. J Urol. 1993; 149: 1256–1257.PubMedGoogle Scholar
  57. 57.
    Kaiser FE, Korenman SG. Impotence in diabetic men. Am J Med. 1988; 85 (suppl 5A): 147–152.PubMedCrossRefGoogle Scholar
  58. 58.
    Fouriner GR Jr, Juenemann KP, Lue TF, et al. Mechanisms of venous occlusion during canine penile erection: an anatomic demonstration. J Urol. 1987; 137: 163–167.Google Scholar
  59. 59.
    Morley JE, Melmed S. Gonadal dysfunction in systemic disorders. Metabolism. 1979; 28: 1051–1073.PubMedCrossRefGoogle Scholar
  60. 60.
    Wabrek AJ, Burchell RC. Male sexual dysfunction associated with coronary heart disease. Arch Sex Behay. 1980; 9: 69–75.CrossRefGoogle Scholar
  61. 61.
    Morley JE, Korenman SG, Kaiser FE, et al. Relationship of penile brachial pressure index to myocardial infarction and cerebrovascular accidents in older men. Am J Med. 1988; 84: 445–448.PubMedCrossRefGoogle Scholar
  62. 62.
    Virag R, Bowilly R, Frydman D. Is impotence an arterial disorder? Lancet. 1985; 1: 181–184.PubMedCrossRefGoogle Scholar
  63. 63.
    Foulks CJ, Cushner HM. Sexual dysfunction in the male dialysis patient: pathogenesis, evaluation and therapy. Am J Kidney Dis. 1986; 8 (4): 211–222.PubMedGoogle Scholar
  64. 64.
    Semple P d’A, Beastall GH, Brown TM, et al. Sex hormone suppression and sexual impotence in hypoxic pulmonary fibrosis. Thorax. 1984; 39: 46–51.PubMedCrossRefGoogle Scholar
  65. 65.
    Kim N, Vardi Y, Padma Nathan H. Oxygen tension regulates the nitric oxide pathway. Physiological role in penile erection. J Clin Invest. 1993; 91: 437–442.PubMedCrossRefGoogle Scholar
  66. 66.
    Aasebo U, Gyltnes A, Bremnes RM, et al. Reversal of sexual impotence in male patients with chronic obstructive pulmonary disease and hypoxemia with long-term oxygen therapy. J Steroid Biochem Molec Biol. 1993; 46: 799–803.PubMedCrossRefGoogle Scholar
  67. 67.
    Morley JE, Kaiser FE. Impotence in elderly men. Drugs Aging. 1991; 2: 330–344.CrossRefGoogle Scholar
  68. 68.
    National Institutes of Health. Consensus development conference statement: impotence. Int J Impotence Res. 1993; 5: 181–199.Google Scholar
  69. 69.
    Lavoisier P, Proulx J, Courtois F, et al. Bulbocavernosus reflex: its validity as a diagnostic test of neurogenic impotence. J Urol. 1989; 141: 311–314.PubMedGoogle Scholar
  70. 70.
    Carroll JL, Ellis D, Bagley DH. Impotence in the elderly. Urology. 1992; 39: 226–230.PubMedCrossRefGoogle Scholar
  71. 71.
    Meisler AW, Carey MP. A critical reevaluation of nocturnal penile tumescence monitoring in the diagnosis of erectile dysfunction. J Nery Mental Dis. 1990; 178: 78–89.CrossRefGoogle Scholar
  72. 72.
    Schiavi RC, Schreiner-Engel P. Nocturnal penile turnescence in health aging men. J Gerontol. 1988; 43: M146–150.PubMedCrossRefGoogle Scholar
  73. 73.
    Condra M, Morales A, Surridge D, et al. The unreliability of nocturnal penile tumescence recording as an outcome measurement in the treatment of organic impotence. J Urol. 1986; 135: 280–282.PubMedGoogle Scholar
  74. 74.
    Morales A, Condra M, Reid K. The role of nocturnal penile tumescence monitoring in the diagnosis of impotence: a review. J Urol. 1990; 143: 441–445.PubMedGoogle Scholar
  75. 75.
    Goldstein I, Seroky MB, Nath RL, et al. Vasculogenic impotence: role of the pelvic steal test. J Urol. 1982; 128: 300–306.PubMedGoogle Scholar
  76. 76.
    Aitchison M, Aitchison J, Carter R. Is the penile brachial index a reproducible and useful measurement? Br J Urol. 1990; 66: 202–204.PubMedCrossRefGoogle Scholar
  77. 77.
    Donatucci CF, Lue TF. The combined intracavernous injection and stimulation test: diagnostic accuracy. J Urol. 1992; 148: 61–62.PubMedGoogle Scholar
  78. 78.
    Nisen H, Cormio L. Pharmacotesting with high dose prostaglandin El in impotence. Ann Chir Gynaecol. 1993; 82: 63–68.Google Scholar
  79. 79.
    Buvat J, Lemaire JL, Dehaene R, et al. Venous incompetence: critical study of the organic basis of high maintenance of flow rate during artificial erection test. J Urol. 1985; 135: 796–798.Google Scholar
  80. 80.
    Segraves RT. Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry. 1989; 46: 275–284.PubMedCrossRefGoogle Scholar
  81. 81.
    Segraves RT. Sexual side-effects of psychiatric drugs. Int J Psychiatry Med. 1988; 18: 243–252.PubMedCrossRefGoogle Scholar
  82. 82.
    Anonymous. Drugs that cause sexual dysfunction: an update. Med Lett. 1992; 34 (876): 73–78.Google Scholar
  83. 83.
    Buffum J. Prescription drugs and sexual function. Psychiatr Med. 1992; 10: 181–198.PubMedGoogle Scholar
  84. 84.
    Muller SC, El-Damanhoury H, Ruth J, et al. Hypertension and impotence. Eur Urol. 1991; 19: 29–34.PubMedGoogle Scholar
  85. 85.
    Croog SH, Levine S, Sudilovsky A, et al. Sexual symptoms in hypertensive patients: a clinical trial of antihypertensive medications. Arch Intern Med. 1988; 148: 788–794.PubMedCrossRefGoogle Scholar
  86. 86.
    Bulpitt CJ, Dollery CT, Carne S. A symptom questionnaire for hypertensive patients. J Chron Dis. 1974: 27: 309323.Google Scholar
  87. 87.
    Bansal S. Sexual dysfunction in hypertensive men: a critical review of the literature. Hypertension. 1988; 12: 1–10.PubMedCrossRefGoogle Scholar
  88. 88.
    Weiss RJ. Effects of antihypertensive agents on sexual function. Am Fam Physician. 1991; 44: 2075–2082.PubMedGoogle Scholar
  89. 89.
    Condra M, Morales A, Owen JA, et al. Prevalence and significance of tobacco smoking in impotence. Urology. 1986; 27: 495–498.PubMedCrossRefGoogle Scholar
  90. 90.
    Ryder REJ, Close CF, Moriarty KT, et al. Impotence in diabetes: aetiology implications for treatment and preferred vacuum device. Diabet Med. 1992; 9: 893–898.PubMedCrossRefGoogle Scholar
  91. 91.
    Bemelmans BLH, Meuleman EJH, Doesburg WH, et al. Erectile dysfunction in diabetic men: the neurological factor revisited. J Urol. 1994; 151: 884–889.PubMedGoogle Scholar
  92. 92.
    Foster RS, Mulcahy JJ, Callaghan JT, et al. Role of serum prolactin determination in evaluation of impotent patient. Urology. 1990; 36: 499–501.PubMedCrossRefGoogle Scholar
  93. 93.
    Johnson AR III, Jarow JP. Is routine endocrine testing of impotent men necessary? J Urol. 1992; 147: 1542–1544.PubMedGoogle Scholar
  94. 94.
    Jackson JA, Waxman J, Spiekerman AM. Prostatic complications of testosterone replacement therapy. Arch Intern Med. 1989; 149: 2365–2366.PubMedCrossRefGoogle Scholar
  95. 95.
    Libman E, Fichten CS, Creti L, et al. Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on post prostatectomy sexual adjustment. J Behav Med. 1989; 12: 469–485.PubMedCrossRefGoogle Scholar
  96. 96.
    Jonler M, Riehmann M, Bruskewitz RC. Benign prostatic hyperplasia: current pharmacological treatment. Drugs. 1994; 47: 66–81.PubMedCrossRefGoogle Scholar
  97. 97.
    McConnell JD, Barry MJ, Bruskewitz RC, et al. Benign prostatic hyperplasia: diagnosis and treatment. Clinical Practice Guideline, Number 8. Agency for Health Care Policy and Research Publication #94–0582. Rockville, MD: US Dept of Health and Human Services; 1994.Google Scholar
  98. 98.
    Gilling PJ, Wright WL, Gray JM. Factors associated with sexual dysfunction following transurethral resection of the prostate. NZ Med J. 1988; 101: 484–485.Google Scholar
  99. 99.
    Schover LR. Sexual rehabilitation after treatment for prostate cancer. Cancer. 1993; 71 (supp1): 1024–1030.PubMedCrossRefGoogle Scholar
  100. 100.
    Balducci L, Phillips DM, Gearhart JG, et al. Sexual complications of cancer treatment. Am Fam Physician. 1988; 37: 159–172.PubMedGoogle Scholar
  101. 101.
    Kaiser FE. Sexual function and the older cancer patient. Oncology. 1992; 6: 112–118.PubMedGoogle Scholar
  102. 102.
    Korenman SG, Viosca SP. Use of a vacuum tumescence device in the management of impotence in men with a history of penile implant or severe pelvic disease. J Am Geriatr Soc. 1992; 40: 61–64.Google Scholar
  103. 103.
    Lanigan D, Roobottom C, Choa RG. A modified papaverine test and the use of venous constriction in erectile dysfunction. Int J Impotence Res. 1993; 5: 119–122.Google Scholar
  104. 104.
    Montorsi F, Guazzoni G, Bergamaschi F, et al. Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence. Urology. 1993; 42: 554–558.PubMedCrossRefGoogle Scholar
  105. 105.
    Moriel EZ, Rajfer J. Sodium bicarbonate alleviates penile pain induced by intracavernous injections for erectile dysfunction. J Urol. 1993; 149: 1299–1300.Google Scholar
  106. 106.
    Linet OI, Neff LL. Intracavernous prostaglandin El in erectile dysfunction. Clin Invest. 1994; 72: 139–149.CrossRefGoogle Scholar
  107. 107.
    Godschalk MF, Chen J, Katz PG, et al. Treatment of erectile failure with prostaglandin El: A double-blind, placebo-controlled, dose-response study. J Urol. 1994; 151: 1530–1532.PubMedGoogle Scholar
  108. 108.
    von Heyden B, Donatucci CF, Kaula N, et al. Intracavernous pharmacotherapy for impotence: selection of appropriate agent and dose. J Urol. 1993; 149: 1288 1290.Google Scholar
  109. 109.
    Djamilian M, Stief CG, Kuczyk M, et al. Follow-up results of a combination of calcitonin gene-related peptide and prostaglandin El in the treatment of erectile dysfunction. J Urol. 1993; 149: 1296–1298.PubMedGoogle Scholar
  110. 110.
    Kerfoot WW, Carson CC. Pharmacologically induced erections among geriatric men. J Urol. 1991; 146: 1022 1024.Google Scholar
  111. 111.
    Korenman SG, Viosca SP. Treatment of vasculogenic sexual dysfunction with pentoxifylline. J Am Geriatr Soc. 1993; 41: 363–366.PubMedGoogle Scholar
  112. 112.
    Susset JG, Tessier CD, Wincze J, et al. Effect of yohimbine hydrochloride on erectile impotence: a double-blind study. J Urol. 1989; 141: 1360–1363.PubMedGoogle Scholar
  113. 113.
    Anderson DC Jr, Seifert CF. Topical nitrate treatment of impotence. Ann Pharmacother. 1993; 27: 1203–1205.PubMedGoogle Scholar
  114. 114.
    Cavallini G. Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence. J Urol. 1991; 146: 50–53.PubMedGoogle Scholar
  115. 115.
    Radomski SB, Herschorn S, Rangaswamy S. Topical minoxidil in the treatment of male erectile dysfunction. J Urol. 1994; 151: 1225–1226.PubMedGoogle Scholar
  116. 116.
    Gregoire A. New treatments for erectile impotence. Br J Psychiatry. 1992; 160: 315–326.PubMedCrossRefGoogle Scholar
  117. 117.
    Moul JW, McLeod DG. Negative pressure devices in the explanted penile prosthesis population. J Urol. 1989; 142: 729–731.PubMedGoogle Scholar
  118. 118.
    Tiefer L, Melman A. Adherence to recommendations and improvement over time in men with erectile dysfunction. Arch Sex Behay. 1987; 16: 301–309.CrossRefGoogle Scholar
  119. 119.
    Basoglu M, Yetkin N, Sercan M, et al. Patterns of attrition for psychological and pharmacological treatment of male sexual dysfunction: implications for sex therapy research and cross-cultural perspectives. Sexual Marital Ther. 1986; 1: 179–189.Google Scholar
  120. 120.
    Perez ED, Mulligan T, Wan T. Why men are interested in an evaluation for a sexual problem. J Am Geriatr Soc. 1993; 41: 233–237.PubMedGoogle Scholar
  121. 121.
    Schover LR. Sex therapy for the penile prosthesis recipient. Urol Clin North Am. 1989; 16: 91–98.Google Scholar
  122. 122.
    Irwin MB, Kata EJ. High attrition rate with intracavernous injection of prostaglandin El for impotency. Urology. 1994; 43: 84–87.PubMedCrossRefGoogle Scholar
  123. 123.
    Hollander JB, Gonzalez J, Norman T. Patient satisfaction with pharmacologic erection program. Urology. 1992; 39: 439–441.PubMedCrossRefGoogle Scholar
  124. 124.
    Johnson LE, Morley JE. Impotence in the elderly. Am Fam Physician. 1988; 38: 225–240.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Larry E. Johnson
  • Fran E. Kaiser
  • John E. Morley

There are no affiliations available

Personalised recommendations