Study Finds Link Between Men's Sexual Vitality and Dementia Risk

Men who have trouble getting an erection or whose erection goes away too fast may be at greater risk of cognitive decline later in life, according to new research. The recent study adds to evidence suggesting that erectile dysfunction (ED) can be an early indicator of other health issues.

Here's a look at what the study found regarding sexual vitality and what it could mean for aging men.

What causes a loss of erection during sex?

There are many potential causes of ED, which is defined as the inability to achieve or maintain an erection firm enough for intercourse.

Most of the time, it's a result of vascular issues that inhibit blood flow to the penis, said Martin Gross, M.D., a urologist at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and an assistant professor of surgery at Dartmouth College's Geisel School of Medicine.

Conditions that can damage or hinder the vascular system (and may be more prevalent in older adults) include diabetes, cardiovascular disease, high blood pressure, high cholesterol, smoking, obesity, drug use and alcohol use.

Then there are conditions that make it more challenging to maintain blood in the penis, such as Peyronie's disease, trauma, and radiation or surgery for prostate cancer, Gross said.

Psychogenic erectile dysfunction, which occurs because of psychological or interpersonal factors, is the leading cause of ED in men younger than 40. Conditions and circumstances such as stress, anxiety, depression and, less frequently, relationship issues, can all contribute to psychogenic ED.

What did the study find about sexual vitality and dementia?

The 2022 study, published in The Gerontologist, saw researchers examine the associations between erectile function, sexual satisfaction and cognition in 818 men over time, beginning when the men were an average age of 56. Those men filled out questionnaires about their sexual function and satisfaction and underwent tests to evaluate their memory and thinking skills. They were then surveyed and tested again at about ages 61 and 68.

Most men who reported ED or diminished sexual function at the beginning of the study had lower cognitive scores than men of the same age who didn't have the same sexual health problems. The men who reported lowered sexual function demonstrated faster and more significant declines in memory as they aged.

The study is the first of its kind to track the association between sexual function and cognitive health longitudinally, according to the study authors. However, the findings are observational and demonstrate correlation but not causation. Ultimately, more research is needed.

What could explain the link between sexual vitality and cognitive decline?

Although the study didn't show causation, the link may be explained by the fact that problems that affect the cardiovascular system also affect the brain, said Jagan Kansal, M.D., a Chicago-based urologist and the founder of Down There Urology.

ED is often an early sign of heart disease, and research indicates it may predate a person's first cardiovascular event by up to 10 years.

Since the blood vessels and arteries in the penis are much smaller than those in the heart, vascular disease tends to noticeably affect the penis first, Kansal added. Conditions such as diabetes and high blood pressure can similarly impact the microscopic veins and arteries of the penis before impacting those of the larger organs.

"The same kind of mechanisms can happen in the brain where decreased blood flow can alter the brain's function," Kansal said.

For example, a buildup of plaque in the vessels and arteries can disrupt blood flow to the penis, heart and brain. And that can potentially lead to strokes—one of the leading causes of decline in cognitive abilities—or other neurological damage, according to Michael Werner, M.D., the medical director and founder of Maze Sexual & Reproductive Health, in New York City and Purchase, New York.

High blood pressure and diabetes can damage blood vessels over time, diminishing their ability to dilate and constrict as needed, Kansal said. This can lead to ED, as well as cognitive decline and heart disease as men age.

Are people with dementia more likely to have ED?

About 40 percent to 55 percent of men with dementia and 50 percent of men with Alzheimer's disease experience ED, according to a 2020 study published in the Journal of Psychosexual Health.

Despite ample research indicating a possible correlation, it's still unclear if dementia causes or contributes to ED, Kansal said.

In part, that's because there are many causes of dementia, such as vascular issues, which can contribute to ED independently of cognitive decline. People may also experience psychogenic ED from the stress or loss of interest in sex that may come with dementia, Kansal said.

"It's hard to know if it's a chicken or the egg situation. Is ED a precursor to dementia, or do dementia patients have ED?" Kansal said. "But we know that as blood flow changes, it's not just affecting the penis but can affect the brain, too."

What can you do to protect your brain and overall health later in life?

"I tell patients anything good for the heart or the brain is going to be good for your penis," Kansal said.

Most men will experience ED at some point in their lives, and it may not be preventable, Gross said. However, plenty of evidence shows that a healthy lifestyle can improve erection quality. Research indicates that those same choices can slow the gradual decline in erectile function that most people experience with age.

One of the most crucial steps is to stop—or refrain from—smoking, Kansal said. Another is to maintain control of LDL cholesterol, Werner said. Smoking and high cholesterol are linked to various conditions that can affect multiple body parts, including the penis, heart and brain.

Some of the best ways to manage cholesterol levels, according to research, include:

• Eat a healthy, Mediterranean-style diet.
• Exercise regularly.
• Take medications, such as statins, if necessary.
• Get enough sleep, because it can impact multiple facets of health, from sexual function to body composition and cognitive function.

"If you want to have more high-quality years, you need to take care of your body and brain," Werner said.

What can you do if your erection goes away too fast?

If you're experiencing ED, it's important to talk to your doctor. There's no shame in bringing it up. It is a crucial step to detect and address underlying issues that could impact much more than your performance in the bedroom.

ED is highly treatable. Besides offering medications and erection aids, urologists work to address the underlying cause of sexual dysfunction to ensure better overall health. This often involves collaborating with primary care physicians, cardiologists and other doctors to rule out and address conditions such as heart disease, high blood pressure and diabetes.

"A lot of people are shy or embarrassed to come in for erectile dysfunction because they primarily think they're coming in for a sexual medicine-related complaint. What they need to understand is erectile dysfunction is something that can be a sign of a bigger problem," Kansal said. "When they first start noticing erectile issues, it means something in the body isn't performing as it should be. And it isn't just the penis."

The bottom line

ED isn't something to be ashamed of; it is something to be concerned about and take seriously, Kansal said.

Looking after yourself through habits such as eating a balanced diet, exercising regularly and prioritizing sleep can help you preserve your sexual and overall well-being to enjoy a longer, healthier life.

Getting routine physicals and talking to your doctor about any concerns—including ED—can also help reduce your risk of health issues such as ED, heart disease and potentially, dementia.