Factors Associated with Erectile Dysfunction Among Older Gay Men

Background and Purpose: For many older men, erectile dysfunction (ED) threatens their sexual expression. Yet, experiences of ED among older gay men have not been given adequate attention. Evidence suggests that cultural norms in the gay community prioritizing youthfulness and masculinity affect perceptions of aging among gay men, yet research is limited regarding the impacts of internalized gay ageism (IGA) on outcomes, including erectile function. The purpose of this study is to examine the relationship between IGA and ED among older gay men while also examining factors known to influence ED among general populations of men.

Methods: A cross-sectional web-based online survey was used to collect data on erectile function and other sexual health and wellness factors among older gay men in the Midwest. Eligible participants were (1) aged 50 or older, (2) identified as gay, (3) identified as a man, (4) assigned male at birth, and (5) resided in the Midwest. Independent variables of interest included sociodemographics (e.g., age, race and ethnicity, relationship status), health factors (e.g., HIV status, overall health), health behavior factors (e.g., physical activity, alcohol use before/during sex) and social factors (e.g., internalized gay ageism, internalized homophobia). Statistical analyses included descriptives, bivariate analyses, and a four-stage hierarchical linear regression model.

Results: Among the 181 participants, the mean age was 65.29 years (SD = 9.32) and majority were White (85.6%). Slightly over half of participants were single or widowed compared to being in some form of a relationship (50.3% versus 49.2%). The mean ED score was just over 2 on a 4-point scale (m = 2.23, SD = 1.5) meaning on average participants reported having ED “several times” in the past 12 months. At the bivariate level (p<.10), alcohol use before/during sex (p=.052), physical activity level (p=.039), race/ethnicity (p=.035), age (p<.001), and overall health (p<.001) were significantly associated with ED. In multivariate analysis, only age and overall health remained significant. Age (p=.008) was positively associated with ED and overall health (p=.003) was negatively associated with ED. IGA was not significantly associated with ED.

Conclusions and Implications: While IGA was not associated with ED, this study adds to the existing literature related to sexual health and wellbeing of older gay men. Like previous studies among older men in general, age and overall health predicted ED in older gay men. Clinicians and educators must remain aware of health promoting behaviors that their clients are engaging in, especially if the clients are presenting with ED. Additionally, efforts should be made at the policy level to promote health interventions developed for older gay men, especially as some studies have found ED more prevalent in gay men compared to heterosexual men. Future studies should investigate the factors associated with ED among more diverse samples of older gay men.