Age is strongly associated with risk of sexual dysfunction in both men and women. For many years it was assumed that such a loss of sexuality was natural and inevitable, and therefore little attention was given to sexual behaviour and treatment in this population. However, more recent data have suggested that sexuality remains important into later life for many individuals. Although appreciation of sexuality persists, a decline in sexual activity is typical with advancing age, which is in part attributable to both general health problems and specific sexual dysfunctions, both becoming more prevalent with ageing. The principle sexual health issues in older men include erectile dysfunction and late onset hypogonadism. Although premature ejaculation is prevalent in older men, the bother from this disorder is generally lower in older men. This manuscript consists of a review of the contemporary peer-reviewed literature and attempts to provide insights for the physician treating the geriatric population. We discuss sexual behaviour at older age, and address erectile and androgen biology in older men and the prevalence and aetiology of sexual dysfunction in this population. Furthermore, an overview of contemporary pharmacological treatments for older men's sexual problems is provided.