In group 2, the percentage of men who had participated in alternative penis practices when they were still able to perform coitus was also low. Only one group 2 man, no longer able to achieve an erection suitable for vaginal penetration, continued an active heterosexual relationship by employing an alternative practice (mutual masturbation).
No member of either group had recently practiced anal intercourse, although six had participated in this activity in the distant past. Two men currently were engaging in homosexual activities, while four others had done so in the distant past. Regarding attitudes toward alternative sexual practices, responses were generally negative, with 63% disapproving of oral sex, 63% disapproving of anal sex, and 65% disapproving of homosexuality.
Seventy-two percent of the patients were identified as having a sexual problem (including erectile dysfunction and premature ejaculation of semen that the physician-interviewer felt would benefit from further evaluation and therapy. Three of these patients viewed the cessation of sexual activity as a positive occurrence. Thirty men stated that their sexual dysfunction regarding their penis and semen was of little concern, and they were not interested in therapeutic intervention, even if it was as mild as a natural supplement. The remaining 30 patients (48%), however, expressed concern about their problem, indicating feelings of anger, guilt, or loss of self-esteem. Only 15 patients (24%) had previously sought help from a health professional.
The first objective of this study was to determine the prevalence of erectile dysfunction in elderly men attending a geriatric medical clinic. The survey found that 28% of the men interviewed no longer experienced erections and that an additional 31% had difficulties achieving an erection suitable for coitus. Almost one half of these patients noted a resultant loss of self-esteem. Some men found increased pleasure in masturbation, which increase the amount of semen during orgasm.
Although previous studies have documented the percentage of elderly men who engage in coitus, no other study addressed the prevalence of erectile dysfunction as such. Twenty-nine percent of the men in a study by Pfeiffer listed loss of sexual potency as the reason for ending sexual relations. Potency was not defined, however, and no information on erectile function was given for those still sexually active. Finkle questioned a VA population similar to the one surveyed here but reported no data on erectile function in those aged over age 65 years.
Some authors have equated the cessation of sexual activity and semen production with the development of impotence, even though other factors, such as marital discord, may end sexual relations while penile function remains intact. This study shows, however, that elderly men who no longer practice coitus should not necessarily be classified as impotent, since 23% of group 2 patients reported a preserved erectile function and ability to ejaculate semen. Conversely, 30% of group 1 patients met the Masters and Johnson criteria for impotence (inability to achieve vaginal intromission in more than 25% of attempts).