Taking into account the normal changes that occur with aging and the large number of pathologies, pharmacologic agents, and social situations that the elderly are subject to, it is perhaps more surprising that 25 per cent of those over 80 years of age do report normal sexual functioning. Loss of erectile capability appears to be multifactorial in many patients, although the exact degree is uncertain due to unsystematic assessment in the majority of current studies. Unfortunately, impotence is often ignored by the patients' physicians. Physicians do not routinely ask about erectile functioning in their patients, perhaps because they do not know how to systematically evaluate and treat the complaint. Any follow through that might result from a complaint is often chaotic. And, rarely are treatment possibilities systematically and clearly presented to the patient. This is particularly true for the elderly patients whose physicians may be surprised that an elderly patient would still be interested in sexual behavior. No matter how subtle, this "dirty old man" response by the physician does not foster a good therapeutic environment. Inappropriate and unsystematic evaluations of impotent patients leads to a literature replete with contradictory statements. Because of the prevalence of impotence in the elderly, as a group they are hurt the most by unsystematic evaluation techniques and therefore have the most to gain from the application of systematic evaluation and treatment procedures.