A large Japanese survey reveals that older men’s sexual priorities extend beyond erections, with arousal remaining highly valued even as different functions show distinct age-related patterns of decline.

Study: Health, Aging, and Male Attitudes (HAMA) to sexual function loss in a large web-based survey of 6,000 older Japanese men. Image Credit: Yana Vasileva / Shutterstock

In a recent study accepted for publication in the journal Scientific Reports, a group of researchers evaluated which sexual and reproductive domains older Japanese men most want to preserve and examined how these preferences relate to age and current sexual function.

Background

As populations age and prostate cancer is increasingly diagnosed at earlier stages, more men are undergoing treatment while expecting to maintain a good quality of life afterward.

Nerve-sparing surgery helps preserve erectile function, but sexual health also includes sexual arousal, orgasm, ejaculation, and fertility. However, little is known about which of these functions men value the most or how their reported status differs across age groups.

Understanding these priorities is essential for meaningful discussions between patients and healthcare providers when treatment decisions may affect long-term sexual well-being and overall quality of life.

About the study

The researchers conducted an online cross-sectional survey of 6,000 Japanese men aged 50 or older who were registered with an internet survey company. For the research design, quota sampling was used to ensure broad representation across age groups, with 1,000 men in their 50s, 2,000 in their 60s, 1,500 in their 70s, and 1,500 aged 80 years or older. The survey was conducted from April to July 2026. Participants were instructed to imagine that they were receiving treatment for prostate cancer and answer the questions accordingly.

Information regarding age, marital status, children, household income, occupation, residence, and partner status was gathered. Respondents ranked five sexual and reproductive domains, including sexual arousal, erection, ejaculation, orgasm, and fertility, according to which they would least want to lose.

Sexual arousal was described as sexual desire or heightened sexual feeling, while fertility referred to the ability to have children. They also reported the current status of sexual arousal, erection, ejaculation, and orgasm as retained, declined, almost lost, or not applicable.

In the analysis, “almost lost” was treated as a complete loss. Men who experienced changes in more than one function additionally ranked the order in which those functions had declined or been lost.

Each domain was assessed using a single survey item without a detailed, standardized definition, which may have led respondents to interpret some terms differently.

The researchers used statistical tests to examine whether participants’ priorities differed according to age, current sexual function, and demographic characteristics.

Ethical approval was obtained from the Institutional Review Board, and completion of the web-based questionnaire was regarded as informed consent.

Study results

A total of 6,000 Japanese men aged 50 years or older participated in the survey, with ages ranging from 50 to 111 years and a mean age of 69.8 years (standard deviation [SD], 10.6). Most participants were married (75.9%), while 70.0% had children.

Out of the total, 11.8% of respondents said that they had an active sexual partner, 63% had a partner with minimal sexual activity, and 25.2% had no partner. The total number of men aged 85 years or older was relatively small, at 382, so the main age-group figures were restricted to participants aged 50 to 84, although all 6,000 men were included in the descriptive characteristics.

When participants ranked the five sexual and reproductive domains according to the function they would least want to lose, sexual arousal emerged as the highest priority. It was chosen by 42.8% of the study participants, followed by erection (26.0%), fertility (14.2%), orgasm (9.3%), and ejaculation (7.6%).

The proportion prioritizing sexual arousal remained broadly stable across age groups, with no statistically significant association with age. In contrast, the proportion of men who considered erection the most important function to preserve increased modestly but significantly with age, rising from 22.9% among men in their 50s to 29.2% among those in their 70s. Marital status, having children, household income, occupation, residence, and partner status did not significantly influence which function participants ranked first.

The survey also compared reported sexual function across age groups. Reports that a function was almost lost became more common with increasing age. Among men in their 50s, approximately 5%-7% reported that each function was almost lost. By 80-84 years of age, the proportion reporting that a function was almost lost increased to 53.5% for ejaculation, 45.8% for orgasm, 43.9% for erection, and 29.0% for sexual arousal.

These findings showed that ejaculation was the function most frequently reported as lost, whereas sexual arousal was significantly better preserved in older age. When both decline and loss were considered together, erection showed the earliest age-related pattern of deterioration. It had the highest reported rate of decline or loss across all age groups from 55 to 74 years.

Ejaculation, however, showed a later but more rapid age-related decline after 75 years, eventually becoming the function most frequently lost. This cross-sectional pattern suggested that erectile decline appeared earlier across age groups, whereas ejaculation showed a later but more extensive pattern of loss.

Finally, the relationship between current functional status and perceived importance differed across sexual functions. The importance assigned to sexual arousal and ejaculation did not differ significantly according to whether these functions were retained, declined, or lost.

In contrast, the proportion of men ranking erection as the function they most wanted to preserve increased significantly as erectile function worsened, rising from 23.8% among those with retained function to 28.9% among those reporting complete loss.

The opposite pattern was observed for orgasm, whose perceived importance decreased significantly as function was lost, falling from 11.7% among men with retained orgasm to 6.2% among those reporting complete loss.

Conclusion

The study found that, within this survey sample, sexual arousal was the sexual function that older Japanese men were keenest to retain, regardless of age. Although erection was reported to decline earlier across age groups than the other functions, its perceived importance increased as erectile function worsened, whereas the importance of orgasm decreased after its loss.

Ejaculation was the function most commonly lost in older age, while sexual arousal remained the best preserved. Because the survey used a cross-sectional design and a hypothetical treatment scenario involving an online panel, the findings describe participants' attitudes rather than actual treatment decisions. The participants were community-dwelling internet-panel members rather than patients with prostate cancer, and their health status was not assessed.

These results may help inform future discussions and research about sexual function preservation by considering age, current functional status, and domains other than erection. However, they do not show how patients make treatment decisions or support changes to surgical practice.

Further research is needed to evaluate these preferences among men making actual medical treatment decisions.

Journal reference:

• Kawahara, T., Hashizume, A., Yamazaki, M., Takamoto, D., Ito, H., Takeshima, T., Kuroda, S., Yumura, Y., Uemura, H., Teranishi, J.-I., & Makiyama, K. (2026). Health, aging, and male attitudes (HAMA) to sexual function loss in a large web-based survey of 6,000 older Japanese men. Scientific Reports. DOI:10.1038/s41598-026-65646-7, https://www.nature.com/articles/s41598-026-65646-7