Population surveys have consistently shown in cross-sectional analysis a decrease in sexual function, primarily erectile capacity, associated with aging in men. Individual responses, as discussed in the previous chapter, are variably shaped by attitudes and expectations that contribute personal significance to the sexual change. Although the aged with sexual complaints approach the health-care system in increasing numbers, the majority of older men do not seek sexual help, even though they may experience significant decrements in sexual function (Feldman et al., 1994). Slag et al. (1983) screened over 1000 patients in a medical outpatient clinic for the presence of erectile dysfunction and found that half of the patients with erectile difficulties declined to be examined for this problem. The investigators speculated that older age and the greater number of medical problems noted in this subgroup of patients may have contributed to their lack of interest in pursuing evaluation of their sexual difficulties.

There is limited information on the reasons that lead men to seek clinical assistance for their sexual concerns. Perez, Mulligan and Wan (1993) conducted a large survey of a random sample of male veterans aged 30–99 to assess variables that may contribute to their interest in a sexual evaluation. A hierarchical regression analysis that included measures of sexual function, emotional state, physical state and demographic characteristics showed that the perception of erectile and orgastic difficulties only partially predicted the desire to be referred for medical assessment. Diminished sexual interest and demographic traits (older age, never married, and nonwhite) had significant negative effects on men's motivation to seek a sexual evaluation.