The general considerations for treatment outlined in the National Institutes of Health, Impotence Consensus Statement (1992) remain valid to this day:

1 Psychotherapy and/or behavioral therapy may be useful for patients with erectile dysfunction without evident organic origin or as an adjunct to medical/urological interventions.

2 Treatment should be individualized to meet patient's desires and expectations, preferably including both partners in treatment plans.

3 Although there are several effective therapies, their long-term efficacy is relatively low and there is a high rate of voluntary discontinuation for all forms of erectile dysfunction treatment.

The sexual problems and concerns that lead aging men to approach health-care professionals are not limited, however, to erectile difficulties. As mentioned in previous chapters, life events such as medical illness or retirement, psychological problems such as depression and marital difficulties may induce sexual dissatisfaction which may, or may not, be accompanied by erectile difficulties. The generic model developed by Baltes and Baltes (1990) named selective optimization with compensation, described in Chapter 1, includes a set of propositions that help organize our views about the management and treatment of the sexual problems of aging individuals. The element of selection refers to concentration on those domains that are of high priority for the individual, which may or may not include, depending on the circumstances, sexual expression. It may also entail adjustment of goals and expectations to maximize sexual satisfaction and the sense of control. The element of optimization may involve enhancing the quality of sexual experiences by cognitive, emotional or interpersonal interventions or by modifying life-style factors in accordance to the priority given to sexuality.