What happens to erections after 40?

What changes with erections after 40?

For most men, the change is gradual rather than sudden. Things that were automatic at 25 become a little less so. Common experiences include:

• erections that take longer to build and respond more to direct touch than to thoughts or sight alone;
• erections that are slightly less firm, or fade more easily if attention drifts;
• a longer wait before another erection is possible after orgasm;
• fewer or less noticeable morning erections.

None of these alone means something is wrong. They become a problem when erections are no longer reliable enough for the sex life a man and his partner want.

Is erectile dysfunction normal after 40?

It is common, which is not the same as normal. The Massachusetts Male Aging Study, a well-known survey from the United States, found that about half of men aged 40 to 70 reported some degree of erectile dysfunction, from mild to complete. The likelihood rose with age, and it was closely linked with heart disease, diabetes, high blood pressure, some medicines and mood.

That link with health is the key point. Age matters mostly because it gives other factors time to accumulate.

Why do erections change with age?

Blood vessels. An erection depends on arteries widening quickly and filling the penis with blood. Over the years, smoking, high blood pressure, raised cholesterol, excess weight and diabetes stiffen and narrow arteries. The arteries of the penis are small, so they can feel the effect early. This is why doctors see erectile changes as a possible early warning sign for the heart, which we explain in why erectile dysfunction can be an early health warning.

Hormones. Testosterone levels tend to drift down slowly with age in many men. Testosterone supports desire more than it drives the erection itself. In the European Male Ageing Study, low desire, fewer morning erections and erectile difficulties were the sexual symptoms most linked with low testosterone.

Medicines. Some treatments for blood pressure, depression and prostate symptoms can affect erections or ejaculation. Never stop a prescribed medicine on your own; ask the prescriber whether there is an alternative.

Sleep, stress and mood. Work pressure, family responsibilities, poor sleep and low mood often peak in midlife, and all of them affect sexual function. A single disappointing night can also create worry that makes the next time harder.

Can you improve erections after 40?

In many men, yes. The same habits that protect the heart tend to protect erections.

• Move more. Regular activity that raises your heart rate supports blood vessel health.
• Manage weight. A randomised trial published in JAMA in 2004 followed obese men with erectile dysfunction for two years. Those who reduced calories and increased physical activity had better erectile function scores than the control group, and about a third regained normal erectile function.
• Stop smoking and keep alcohol moderate.
• Protect your sleep. Loud snoring with daytime sleepiness is worth mentioning to a doctor.
• Know your numbers. Blood pressure, blood sugar and cholesterol are easy to check and easy to overlook.

Lifestyle changes take time and do not work for everyone. They are a foundation, not a replacement for medical help.

What treatments are there?

Guidelines describe a step-by-step approach. Tablets that improve blood flow, such as sildenafil and tadalafil, are commonly used first when they are suitable; we compare them in sildenafil vs tadalafil. Other options include vacuum devices, injections and, for men for whom other treatments have not worked, penile implants. A doctor decides which is appropriate after an assessment.

When to see a doctor

See a doctor if erections have been unreliable for a few months, if the change came on suddenly, or if it comes with low desire, tiredness or symptoms such as chest pain on exertion. An honest conversation early on is far easier than years of avoiding the subject. Our erectile dysfunction guide explains what an assessment involves.

Questions men also ask

Is it normal to need more stimulation to get an erection after 40?

Yes. Many men find that erections become less automatic with age and respond more to direct touch. On its own, this is a common change rather than a problem.

Can erections improve after 40?

Often, yes. Addressing weight, activity, smoking, alcohol, sleep and conditions such as diabetes or high blood pressure can improve erections in some men, and medical treatments are available when needed.

Should I get my testosterone checked if my erections change?

A doctor may suggest it, particularly if you also have low desire, fewer morning erections or unexplained tiredness. Low testosterone is only one of several possible causes.

Sources & further reading

1. Journal of Urology Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study (opens in a new tab) (1994) Feldman HA, et al.
2. JAMA Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial (opens in a new tab) (2004) Esposito K, et al.
3. New England Journal of Medicine Identification of late-onset hypogonadism in middle-aged and elderly men (opens in a new tab) (2010) Wu FCW, et al.
4. European Urology European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction (opens in a new tab) (2021) Salonia A, et al.

This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.