Prevalence and Predictors of Sexual Problems in Men Aged 75–95 Years: A Population-Based Study Zoë Hyde, MPH,* † Leon Flicker, MBBS, PhD,* † Graeme J. Hankey, MD, †‡ Osvaldo P. Almeida, MD, PhD,* §¶ Kieran A. McCaul, MPH, PhD,* † S.A. Paul Chubb, PhD, † ** and Bu B. Yeap, MBBS, PhD ††† *Western Australian Centre for Health and Ageing, Centre for Medical Research, Western Australian Institute for Medical Research, University of Western Australia, Crawley, WA, Australia; † School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia; ‡ Department of Neurology, Royal Perth Hospital, Perth, WA, Australia; § School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia; ¶ Department of Psychiatry, Royal Perth Hospital, Perth, WA, Australia; **PathWest, Department of Biochemistry, Fremantle Hospital, Fremantle, WA, Australia; †† Department of Endocrinology and Diabetes, Fremantle Hospital, Fremantle, WA, Australia DOI: 10.1111/j.1743-6109.2011.02565.x ABSTRACT Introduction. Hypogonadism is associated with impaired libido and erectile dysfunction in young men, but the causes of sexual dysfunction in older men are less well understood. Aim. To determine the prevalence and predictors of sexual problems in older men. Main Outcome Measure. Sexual problems, as assessed by a self-reported questionnaire. Methods. This was a population-based, cohort study of 3,274 community-dwelling men aged 75–95 years (mean 82 years) from Perth, Western Australia. Questionnaires in 2001–2004 and 2008–2009 assessed social and medical risk factors. Sex hormones were measured in 2001–2004. Predictors of sexual problems, measured in 2008–2009, were assessed cross-sectionally in the entire sample, and longitudinally in a subset of 1,744 men with sex hormone data. Results. Sexual problems were highly prevalent, with 49.4% (95% confidence interval 47.7% to 51.1%) reporting erectile problems, 47.7% (45.9% to 49.4%) lacking interest in sexual activity, 38.7% (37.0% to 40.3%) unable to climax, and 20.4% (19.1% to 21.8%) anxious about their ability to perform sexually. Painful and unpleasurable sex were less common (<5%). Overall, 72.0% (70.5% to 73.6%) reported at least one problem. In multivariate binary logistic regression analyses, cardiovascular disease, diabetes, depression, prostate disorders, and insomnia were the factors most commonly associated with sexual problems. Low testosterone levels were associated with lack of interest in sex, but not with other complaints. Conclusions. Sexual problems are common in elderly men. Chronic disease, depression, and insomnia appear to be the main modifiable risk factors. Androgen deficiency is unlikely to be a major cause of sexual problems in this age group. Hyde Z, Flicker L, Hankey GJ, Almeida OP, McCaul KA, Chubb SAP, and Yeap BB. Prevalence and predictors of sexual problems in men aged 75–95 years: A population-based study. J Sex Med 2012;9:442–453. Key Words. Hypogonadism; Sexual Dysfunction; Testosterone; Testosterone Replacement Therapy; Ageing; Men Introduction S exuality is an important component of quality of life across the lifespan [1]. Sexual activity appears to confer health benefits [2,3], while sexual dysfunction adversely affects mood and overall life satisfaction [4]. Although sexual activity decreases [5–7], while sexual problems increase [4], an asexual state should not be regarded as an inevi- table outcome of ageing [1]. However, despite the relationship with quality of life, sexual problems in older people are often ignored by clinicians [8], and epidemiological data for this age group are limited. Sexual problems may be organic or psychogenic in nature, and can be grouped into the following categories in males: (i) diminished or absent sexual interest; (ii) erectile dysfunction; (iii) premature 442 J Sex Med 2012;9:442–453 © 2011 International Society for Sexual Medicine