Psychobiological protective factors modifying the association between age and sexual health in men: Findings from the Men's Health 40+ Study
Open accessAbstract
Sexual health severely decreases with age. For males older than 40 years, erectile dysfunction (ED) is the most common sexual disorder. Although physical and psychological risk factors for ED have been identified, protective factors are yet to be determined. To date, no study has examined endocrine and psychosocial factors in parallel with regard to their modifying effect on the age-related increase in ED. Two hundred and seventy-one self-reporting healthy men aged between 40 and 75 years provided both psychometric data on sexual function and a set of potential psychosocial protective factors, and saliva samples for the analysis of steroid hormones and proinflammatory cytokines. Around 35% of the participants reported at least a mild form of ED. Direct associations with ED were identified for perceived general health, emotional support, relationship quality, intimacy motivation but not for steroid hormones or proinflammatory markers. Moderation analyses for the association between age and ED revealed positive effects for testosterone (T), dehydroepiandrosterone (DHEA), perceived general health, emotional support, intimacy motivation, and a negative effect for interleukin-6 (all p < .05; f 2 > .17). Group differences between older men with and without ED emerged for T, DHEA, and psychometric measures such as perceived general health, emotional support, satisfaction with life, and intimacy motivation (all p < .05; d > .3). Both psychosocial and endocrine parameters moderated the association between age and sexual health. Perceived general health, emotional support, intimacy motivation, and relationship quality emerged as psychosocial protective factors against ED. Higher T and DHEA and lower interleukin-6 levels also buffered against an age-related increase in ED.
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Lack of motivation may interfere with treatment adherence or may cause men to decide not to pursue any treatment at all.
“Age should be taken into account when proposing a treatment because lack of motivation may interfere with treatment adherence or may cause men to decide not to pursue any treatment at all.83,95”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [95]
The Discussion (page unavailable) reports an age-related loss of intimacy motivation among men with erectile dysfunction and calls for age-tailored treatment approaches. It does not say that low motivation interferes with treatment adherence or leads men to decline treatment. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPossible reasons for treatment drop-out include treatment costs and side-effects, recovery of natural erectile capability, lack of interest in sexual activity, lack of spontaneity and artificial intimacy associated with sexual aids, embarrassment, new demands inducing performance anxiety, unrealistic expectations, and relational issues such as communication problems, lack of confidence, and lackof
“Although more work is needed to identify the exact reasons for treatment drop-out, there is a possible role of treatment costs and side-effects, recovery of natural erectile capability, lack of interest in sexual activity, lack of spontaneity and artificial intimacy associated with the use of sexual aids, embarrassment, new demands that induce performance anxiety, unrealistic expectations, and”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [95]
The Introduction and Conclusion discuss risk and protective factors for erectile dysfunction, including relationship quality, but do not address why men drop out of treatment. Searches for treatment drop-out, costs, side effects, sexual aids, and discontinuation found no passage supporting the proposed reasons. (LLM, conf=0.78)
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- Authors
- Walther, A., Mahler, F., Debelak, R., & Ehlert, U.
- Affiliations
- University of Zurich (CH)
- Corresponding author
- Ehlert, Ulrike
- Venue
- American Journal of Men s Health
- Publisher
- SAGE Publications
- Published
- 2017-02-13
- Volume
- 11
- Issue
- 3
- Pages
- 737-747
- ISSN
- 1557-9883 (ISSN-L)
- 1557-9891
- PMC
- PMC5675228
- OpenAlex
- W2588214242
- Cited by
- 25
- References
- 42
- Citations by year
- 2026: 1 · 2025: 4 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 5
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- American Journal of Men s Health (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- University Research Priority Program – Dynamics of Healthy Aging
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- erectile dysfunction, protective factors, older men, testosterone, dehydroepiandrosterone, interleukin-6, inflammatory cytokines, general health perception, emotional support, relationship quality, sexual health, men's health
- MeSH terms
- Adaptation, Psychological, Adult, Age Factors, Aged, Humans, Erectile Dysfunction, Male, Middle Aged, Gonadal Steroid Hormones, Interleukin-6, Cluster Analysis, Men's Health, Self Report
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