Five sexual health myths urologists hear every week

Sexual health is surrounded by half-truths picked up from friends, films and the internet. Some are harmless. Others stop men from asking for help, or send them looking for the wrong solution. Here are five common misconceptions and what the research says.

Is erectile dysfunction just a normal part of getting older?

Erectile dysfunction (ED) does become more common with age. In the Massachusetts Male Aging Study, published in 1994, about 52% of men aged 40 to 70 reported some degree of it, and it was more frequent in older men and in those with conditions such as heart disease, diabetes and high blood pressure.

But "more common" is not the same as "inevitable". Many older men have reliable erections, and when ED does appear there is usually a reason behind it, from blood vessel health and medicines to stress and sleep. European guidelines treat ED as a medical condition to be assessed and treated, not something to put up with. It can also be an early signal about heart health, which is one more reason not to dismiss it.

Is my penis smaller than average?

Probably not. A 2015 review in BJU International pooled measurements taken by health professionals in more than 15,000 men. It found an average erect length of about 13.1 cm and an average flaccid length of about 9.2 cm, which is shorter than many men assume.

Much of the worry comes from comparison with pornography or from looking down at yourself, which foreshortens the view. Most men who are concerned about their size turn out to be within the normal range. If the worry is affecting your confidence or relationships, that is worth talking about in its own right.

Is low sex drive always caused by low testosterone?

No. Testosterone matters for desire, but it is only one factor. The European Male Ageing Study, published in 2010, found that poor morning erections, low sexual desire and erectile problems were the symptoms most closely linked with low testosterone. Yet the combination of those symptoms with genuinely low testosterone was uncommon, affecting about 2% of men aged 40 to 79.

Stress, depression, relationship difficulties, poor sleep, alcohol, some medicines and long-term illness can all reduce libido. That is why a blood test on its own rarely tells the whole story.

Do erection tablets work without arousal?

They do not. Medicines such as sildenafil and tadalafil work by supporting the body's natural response to sexual stimulation. Without arousal, nothing much happens. They are prescription medicines in many countries, they must not be combined with nitrate heart medicines, and a doctor decides whether they are suitable and at what dose.

It also means that if the tablets seem not to work, the cause may be timing, lack of stimulation, anxiety or an underlying condition, rather than the medicine itself. A review with a doctor often helps.

Does sex stop mattering after 60?

Not for many people. A national survey of more than 3,000 American adults aged 57 to 85, published in 2007, found that many remained sexually active. Activity declined with age and was closely tied to general health. About half of the sexually active men reported at least one bothersome sexual problem, most often difficulty with erections.

In other words, interest often continues, and the problems that do appear are frequently health-related and treatable. Age is not a reason to stop asking questions.

What to take away

• Changes have causes. A persistent change in erections, desire or ejaculation is worth mentioning to a doctor.
• Comparison misleads. Real-world measurements and real-world sex lives look different from what media suggest.
• One test rarely explains everything. Hormones, blood vessels, nerves, mind and relationship all play a part.

For more beliefs put to the test, see our Myth vs Fact page, or read our male sexual health guide.

Questions men also ask

Is it normal to lose erections occasionally?

Yes. Occasional difficulty, for example when tired, stressed or after drinking, is common. It is worth seeing a doctor when the problem is persistent or getting worse.

Should I get my testosterone checked if my libido is low?

It can be part of an assessment, but guidelines recommend testing alongside a review of symptoms, health and medicines, because low libido has many 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. BJU International Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men (opens in a new tab) (2015) Veale D, 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.
5. New England Journal of Medicine A Study of Sexuality and Health among Older Adults in the United States (opens in a new tab) (2007) Lindau ST, 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.