Age, health status and gender affect sexual activity. Gender differences in sexual activity indicate that men are more likely than women to being sexually active with a good quality sex life. Further, gender difference increase with age where it is reported that 39% of men compared to 17% of women aged 75 to 85 years were sexually active. The provision of good health is likely to correspond with men and women being more sexually active.

Further, men are more affected by poor health with poor health having a greater impact on male sexual activity. Men are likely to suffer from a range of age-related changes to sexual function. They may experience delay in erection, diminished intensity and duration of organism and decreased force of seminal emission.

First line therapy for ED is phosphodiesterase-5 (PDE-5) inhibitors because of their efficacy, ease of use, and favorable side effect profile. Viagra, Cialis and Levitra appear to be equally effective, but Cialis has a longer duration of action. Current practice guidelines suggest that the choice of PDE-5 inhibitor should be based upon on the patient’s preferences, including cost, ease of use, and adverse effects. Once medical therapy fails, then there are several second-line therapies such as penile self-injectables and vacuum devices. The surgical implantation of penile prosthesis is reserved for men who cannot use or who have not responded to first and second-line therapies