Understanding Erectile Dysfunction in Men Over 60

Erectile dysfunction is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It becomes increasingly prevalent with age due to multiple factors including cardiovascular disease, diabetes, hormonal changes such as low testosterone, lifestyle influences, and psychological contributors.

In men over 60, ED is often a warning sign of underlying vascular or metabolic disease. Since erectile function depends heavily on healthy blood flow and nerve function, conditions that impair vascular health—such as hypertension, diabetes, and hyperlipidaemia—are closely linked to ED.

Because ED can precede cardiovascular disease (CVD) symptoms by years, the condition provides an early opportunity to detect and address potentially serious disorders. Therefore, comprehensive assessment and management are essential.

Lifestyle Modifications: The Cornerstone of ED Management

For men over 60 in Ireland, lifestyle changes form the foundation of managing ED. These changes not only support sexual function but also enhance overall cardiovascular and metabolic health.

Key lifestyle recommendations include:

• Increasing Physical Activity Regular aerobic exercise such as walking, cycling, or swimming improves blood flow and endothelial function. Studies indicate that aerobic exercise can improve erectile function in older men.

• Healthy Diet A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats supports cardiovascular health and weight management, both important for reducing ED risk.

• Smoking Cessation Smoking damages blood vessels and contributes to endothelial dysfunction, which can affect erectile quality. Quitting smoking supports both ED management and general health.

• Limiting Alcohol and Avoiding Illicit Drugs Excessive alcohol and recreational drug use can impair sexual function and complicate ED treatment.

• Optimizing Control of Chronic Conditions Well-managed diabetes, hypertension, and lipid disorders reduce vascular damage that can cause ED.

• Review of Medications Some medications commonly used in older adults may contribute to ED (e.g., SSRIs, certain antihypertensives). Discussing medication side effects with healthcare providers can help identify alternatives that minimize sexual dysfunction.

These lifestyle changes require commitment and are recommended as a foundational approach alongside any medical treatments.

Comprehensive Medical Assessment

Men over 60 presenting with ED in Ireland are advised to undergo thorough medical evaluation. This typically includes:

• Detailed medical and sexual history to identify organic versus psychological causes.
• Physical examination focusing on cardiovascular health and genital assessment.
• Screening blood tests for diabetes (HbA1c), lipid profile, testosterone levels (morning serum sample), renal and liver function, and thyroid function.
• Cardiovascular evaluation including blood pressure measurement and peripheral pulse checks to assess for vascular disease.
• Psychological screening to address anxiety, depression, or relationship issues contributing to ED.

This thorough approach helps identify and manage contributing factors properly, avoiding missed diagnoses such as cardiovascular disease or hypogonadism.

Pharmacological Treatments: PDE5 Inhibitors as First-Line Therapy

Phosphodiesterase type 5 inhibitors (PDE5i) remain the primary pharmacological treatment for ED and are effective in many men. Common PDE5 inhibitors include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil and others

PDE5 inhibitors increase blood flow to the penis by enhancing the nitric oxide-cGMP pathway in erectile tissue. They require sexual stimulation to be effective and are generally well tolerated with minimal side effects.

In Ireland, men over 60 can access these medications via prescription. Some PDE5 inhibitors also may be obtained after pharmacist consultation. Tadalafil offers a longer duration of action, useful for daily dosing regimens that promote spontaneity.

It is important to note that PDE5 inhibitors are contraindicated in men taking nitrates for heart conditions due to the risk of severe hypotension, and a healthcare provider should evaluate such risks.

Non-Invasive Alternatives: Vacuum Erection Devices

For those who cannot tolerate or do not respond to PDE5 inhibitors, or who prefer non-drug options, vacuum erection devices (VEDs) provide a safe and effective alternative.

VEDs consist of a hollow cylindrical tube placed over the penis, connected to a pump that creates a vacuum to draw blood into the penile tissues. Once an erection is achieved, a constriction ring is slipped onto the base of the penis to maintain the erection during intercourse.

Advantages of VEDs include:

• Non-invasive and drug-free approach
• Minimal side effects
• Suitable for men with multiple comorbidities

Using the device requires some manual dexterity, and initial instruction by a healthcare professional can improve success rates and satisfaction.

Additional Therapies: Local Prostaglandin and Injection Treatments

If first-line treatments are ineffective or contraindicated, additional options include:

• Intraurethral suppositories (IUS): Small pellets of prostaglandin E1 inserted into the urethral opening to stimulate an erection.
• Topical creams: Prescription-only creams applied to the urethra that increase local blood flow.
• Intracavernosal injections (ICI): Direct injection of vasoactive agents such as alprostadil into the side of the penis. This method produces an erection typically within 10-15 minutes without requiring sexual stimulation.

These therapies require proper training and medical supervision because of potential side effects like pain, bruising, burning sensation, and rare but serious priapism (prolonged erection). They offer alternative options for men who cannot use PDE5 inhibitors.

Addressing Hormonal Factors: Testosterone Replacement Therapy

Low testosterone (hypogonadism) is more common in men over 60 and may contribute to ED and reduced sexual desire. Testosterone replacement therapy (TRT) may be considered for men with confirmed low serum testosterone alongside symptoms.

In clinical practice in Ireland:

• TRT is used mainly for men with hypogonadism who do not fully respond to PDE5 inhibitors or who have low libido.
• Testosterone levels are measured by morning blood samples.
• TRT requires careful monitoring to assess prostate health (PSA levels), hematocrit, and cardiovascular status.
• Side effects can include fluid retention, acne, behavioral changes, and potential cardiovascular risks.

TRT is not a primary treatment for ED but can play a supportive role when hormonal deficiency is diagnosed.

Psychosexual Counseling to Support Psychological Wellbeing

Psychological factors such as stress, anxiety, depression, or relationship difficulties often co-exist or exacerbate ED, especially in older men coping with multiple life changes.

Referral to psychosexual counseling or therapy can:

• Aid in overcoming performance anxiety
• Improve communication with partners
• Address underlying emotional or relational issues

Counseling is an effective adjunct to medical therapy and sometimes serves as sole treatment for psychogenic ED.

Emerging Treatments: Regenerative Therapy

A developing treatment available in Ireland is regenerative therapy, offered by specialist clinics including Regenecare in Dublin. This approach aims to use the body’s natural healing mechanisms to repair and rejuvenate penile tissue.

Regenerative therapy works by:

• Stimulating the growth of new blood vessels (neovascularization)
• Repairing damaged erectile tissue
• Reducing inflammation

Benefits of regenerative therapy include a non-invasive procedure with minimal discomfort and potential for improvement in erectile function over months to years.

While promising, regenerative therapies are not yet widely covered by public health schemes and typically require private consultation and treatment.

Penile Implant Surgery: An Option for Resistant ED

For men over 60 who do not respond to conservative or medical therapies, penile prosthesis implantation offers a surgical treatment option.

Two main types of implants are available:

• Inflatable implants (two- or three-piece): Provide a natural erection with control over rigidity and flaccidity.
• Malleable (semi-rigid) implants: Simpler bendable rods that maintain firmness.

Surgical risks include infection, device malfunction, and the usual risks associated with anesthesia. Patient satisfaction rates tend to be high, particularly after failed less invasive treatments.

Costs and Access in Ireland 2025

Detailed information on costs and public funding for ED treatments specific to men over 60 in Ireland is limited; typical pathways include:

• Initial assessment and lifestyle intervention by general practitioners or urologists covered by public healthcare.
• PDE5 inhibitors available via prescription; some require payment, others may be partially reimbursed depending on schemes.
• VEDs and additional therapies often require private purchase or specialist referral.
• Regenerative therapies and penile implants are usually accessed privately.

Men are encouraged to consult openly with healthcare providers to explore accessible options aligned with their health status and preferences.

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Summary

Managing erectile dysfunction in men over 60 in Ireland in 2025 involves a comprehensive approach prioritizing lifestyle modifications, thorough medical assessment, and a range of treatment options. Initial focus on exercise, diet, quitting smoking, and controlling chronic diseases lays the groundwork for potential improvement. Pharmacological treatments with PDE5 inhibitors are effective first-line options. Non-invasive devices, local therapies, hormone replacement, psychosexual counseling, regenerative therapies, and surgical implants provide a spectrum of personalized solutions. Open discussion with healthcare professionals can support men in understanding available approaches to address ED.

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Sources

• [Irish Pharmacist: Erectile dysfunction

  May 2025](https://irishpharmacist.ie/clinical/in-focus/erectile-dysfunction/)

• [The Urology Foundation: Erectile Dysfunction

  April 2024](https://www.theurologyfoundation.org/urology-health/male-reproductive-organs-conditions/erectile-dysfunction/)

• Regenecare: Regenerative Therapy for Erectile Dysfunction in Ireland Disclaimer: All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. The information and materials contained in these pages and the terms, conditions and descriptions that appear, are subject to change without notice.