This book goes a long way towards disentangling the complexities of an increasingly common clinical situation. Imagine a 70-year-old man with depression, complaining that he is having problems achieving and maintaining erections. He suffers from diabetes, and is taking antihypertensives and an antidepressant. How much of his sexual dysfunction is a complication of his diabetes, a symptom of his depression, a side-effect of his medication or just to be expected in a man of his age?

In this excellent book Schiavi reviews the available research findings to elucidate the current state of our knowledge in this field. This involves a truly multi-disciplinary overview, including the science of ageing in the introductory chapters to give some estimate of how the ‘healthy’ ageing process affects sexual behaviour in men. Later chapters attempt a thorough and systematic review of the factors that can affect sexual function in older men, including medical and psychiatric illness and the effects of drugs (including alcohol). There is even a very welcome chapter reviewing what is known about the sexuality of older homosexual men, although this partly serves to demonstrate the paucity of research in this area.

The book's main strength is the author's insistence on the importance of the social, cultural and relationship context of sexual behaviour. In an era of sexual medicine, when male sexual dysfunction seems to have been reduced to a mechanistic problem to be solved by swallowing a tablet of sildenafil, it is refreshing to find a leading researcher taking this stance. He deplores the use of outcome measures such as coital frequency when motivational and affective dimensions of the sexual experience are ignored. He berates clinics that ignore the organic factors so common in the sexual problems of the ageing male, but equally criticises medical approaches where the evaluation of psychological factors is “cursory at best”, with the focus on the penis at the expense of the individual and the context of his life. This is emphasised by the helpful and judicious use of case histories to illustrate the full range of presenting problems.

This is an authoritative yet readable book that should be helpful not just to those working specifically with older patients or in psychosexual clinics, but to any clinician interested in sexuality and how people in our society come to terms with the physical and psychological changes of ageing.