Skip to main content
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1985 Apr;142(4):499–505.

Evaluation of Impotence in Older Men

Susan Stanik Davis 1,2,3, Sharon P Viosca 1,2,3, Mordechai Guralnik 1,2,3, Clara Windsor 1,2,3, Arun J Mehta 1,2,3, Stanley G Korenman 1,2,3, Matthew W Buttiglieri 1,2,3, J Dennis Baker 1,2,3
PMCID: PMC1306072  PMID: 4013264

Abstract

Careful evaluation was carried out in 93 men older than 50 with erectile dysfunction. Their mean age was 61 years and the disorder had been present for a mean of 4.5 years. While 14 men (15%) had psychosocial factors that may have been pertinent, only 2 scored poorly on an Affect Balance Scale and 3 were receiving psychoactive medications. Results of nocturnal penile tumescence were abnormal in 91%. In 39% penile-brachial pressure indices were suggestive of pelvic vascular disease and in 9% were consistent with a pelvic “steal syndrome.” Pelvic or peripheral nerve conduction disorders were also commonly seen in 54%. Endocrinopathy may have contributed to the dysfunction in 35%. Twenty-one men had diabetes mellitus, two new cases of hypothyroidism were discovered and hypogonadism was diagnosed definitely in four and considered likely in five others. Coexisting medical conditions were found in more than 90% of the men, especially hypertension, use of antihypertensive medications and atherosclerotic disease. Previous prostatectomies (19%) and vasectomies (30%) were common in the surgical histories.

Given the wide range of disorders uncovered in older men complaining of impotence, diagnostic study of potential causes may lead to a more rational approach for the evaluation and management of these men.

Full text

PDF
499

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bancroft J., Wu F. C. Changes in erectile responsiveness during androgen replacement therapy. Arch Sex Behav. 1983 Feb;12(1):59–66. doi: 10.1007/BF01542116. [DOI] [PubMed] [Google Scholar]
  2. Collins W. E., McKendry J. B., Silverman M., Krul L. E., Collins J. P., Irvine A. H. Multidisciplinary survey of erectile impotence. Can Med Assoc J. 1983 Jun 15;128(12):1393–1399. [PMC free article] [PubMed] [Google Scholar]
  3. Davidson J. M., Chen J. J., Crapo L., Gray G. D., Greenleaf W. J., Catania J. A. Hormonal changes and sexual function in aging men. J Clin Endocrinol Metab. 1983 Jul;57(1):71–77. doi: 10.1210/jcem-57-1-71. [DOI] [PubMed] [Google Scholar]
  4. Forest M. G., Rivarola M. A., Migeon C. J. Percentage binding of testosterone, androstenedione and dehydroisoandrosterone in human plasma. Steroids. 1968 Sep;12(3):323–343. doi: 10.1016/0039-128x(68)90025-1. [DOI] [PubMed] [Google Scholar]
  5. Goldstein I., Siroky M. B., Nath R. L., McMillian T. N., Menzoian J. O., Krane R. J. Vasculogenic impotence: role of the pelvic steal test. J Urol. 1982 Aug;128(2):300–306. doi: 10.1016/s0022-5347(17)52898-0. [DOI] [PubMed] [Google Scholar]
  6. Harman S. M., Tsitouras P. D. Reproductive hormones in aging men. I. Measurement of sex steroids, basal luteinizing hormone, and Leydig cell response to human chorionic gonadotropin. J Clin Endocrinol Metab. 1980 Jul;51(1):35–40. doi: 10.1210/jcem-51-1-35. [DOI] [PubMed] [Google Scholar]
  7. Krane R. J., Siroky M. B. Studies on sacral-evoked potentials. J Urol. 1980 Dec;124(6):872–876. [PubMed] [Google Scholar]
  8. Kwan M., Greenleaf W. J., Mann J., Crapo L., Davidson J. M. The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men. J Clin Endocrinol Metab. 1983 Sep;57(3):557–562. doi: 10.1210/jcem-57-3-557. [DOI] [PubMed] [Google Scholar]
  9. Marshall P., Morales A., Surridge D. Unreliability of nocturnal penile tumescence recording and MMPI profiles in assessment of impotence. Urology. 1981 Feb;17(2):136–139. doi: 10.1016/0090-4295(81)90221-1. [DOI] [PubMed] [Google Scholar]
  10. Michal V., Kramár R., Pospíchal J. EXternal iliac "steal syndrome". J Cardiovasc Surg (Torino) 1978 Jul-Aug;19(4):355–357. [PubMed] [Google Scholar]
  11. Montague D. K., James R. E., Jr, deWolfe V. G., Martin L. M. Diagnostic evaluation, classification, and treatment of men with sexual dysfunction. Urology. 1979 Dec;14(6):545–548. [PubMed] [Google Scholar]
  12. Morgan R. J., Pryor J. P. Th investigation of organic impotence. Br J Urol. 1980 Dec;52(6):571–574. doi: 10.1111/j.1464-410x.1980.tb03117.x. [DOI] [PubMed] [Google Scholar]
  13. O'Connor S., Baker H. W., Dulmanis A., Hudson B. The measurement of sex steroid binding globulin by differential ammonium sulphate precipitation. J Steroid Biochem. 1973 Jul;4(4):331–339. doi: 10.1016/0022-4731(73)90002-2. [DOI] [PubMed] [Google Scholar]
  14. Phillips G. B., Castelli W. P., Abbott R. D., McNamara P. M. Association of hyperestrogenemia and coronary heart disease in men in the Framingham cohort. Am J Med. 1983 May;74(5):863–869. doi: 10.1016/0002-9343(83)91078-1. [DOI] [PubMed] [Google Scholar]
  15. Phillips G. B. Evidence for hyperestrogenemia as the link between diabetes mellitus and myocardial infarction. Am J Med. 1984 Jun;76(6):1041–1048. doi: 10.1016/0002-9343(84)90855-6. [DOI] [PubMed] [Google Scholar]
  16. Queral L. A., Whitehouse W. M., Jr, Flinn W. R., Zarins C. K., Bergan J. J., Yao J. S. Pelvic hemodynamics after aortoiliac reconstruction. Surgery. 1979 Dec;86(6):799–809. [PubMed] [Google Scholar]
  17. Rosner W. A simplified method for the quantitative determination of testosterone-estradiol-binding globulin activity in human plasma. J Clin Endocrinol Metab. 1972 Jun;34(6):983–988. doi: 10.1210/jcem-34-6-983. [DOI] [PubMed] [Google Scholar]
  18. Slag M. F., Morley J. E., Elson M. K., Trence D. L., Nelson C. J., Nelson A. E., Kinlaw W. B., Beyer H. S., Nuttall F. Q., Shafer R. B. Impotence in medical clinic outpatients. JAMA. 1983 Apr 1;249(13):1736–1740. [PubMed] [Google Scholar]
  19. Spark R. F., White R. A., Connolly P. B. Impotence is not always psychogenic. Newer insights into hypothalamic-pituitary-gonadal dysfunction. JAMA. 1980 Feb 22;243(8):750–755. [PubMed] [Google Scholar]
  20. Stanik S., Dornfeld L. P., Maxwell M. H., Viosca S. P., Korenman S. G. The effect of weight loss on reproductive hormones in obese men. J Clin Endocrinol Metab. 1981 Oct;53(4):828–832. doi: 10.1210/jcem-53-4-828. [DOI] [PubMed] [Google Scholar]
  21. Stearns E. L., MacDonnell J. A., Kaufman B. J., Padua R., Lucman T. S., Winter J. S., Faiman C. Declining testicular function with age. Hormonal and clinical correlates. Am J Med. 1974 Nov;57(5):761–766. doi: 10.1016/0002-9343(74)90850-x. [DOI] [PubMed] [Google Scholar]
  22. Wasserman M. D., Pollak C. P., Spielman A. J., Weitzman E. D. Theoretical and technical problems in the measurement of nocturnal penile tumescence for the differential diagnosis of impotence. Psychosom Med. 1980 Nov;42(6):575–585. doi: 10.1097/00006842-198011000-00006. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES