Erectile dysfunction (ED) is common in the ageing man and reliable therapies are needed. The pathophysiology of erectile dysfunction in this patient group mainly includes chronic ischaemia, which triggers the deterioration of cavernous smooth muscle and the development of corporeal fibrosis. The assessment of the ageing man with erectile dysfunction who seeks medical treatment should include a thorough medical and sexual history, a systemic and focused physical examination and selected blood tests. An extensive discussion of the various therapeutic options should follow in order to allow the patient to identify the most suitable alternative. Oral drug therapy represents a safe and efficacious option for most elderly patients.