Sexual arousal trumps erection as older men's top priority, Japanese survey finds

Six thousand Japanese men, ranging in age from 50 to 111, were asked to imagine themselves facing prostate cancer treatment. The researchers wanted to know: which sexual function would you most want to keep? The answer surprised no one who has thought carefully about desire. Sexual arousal—the capacity to feel sexually alive—topped the list. Nearly 43 percent of men chose it as the function they would least want to lose. Erection came second, at 26 percent. Fertility, orgasm, and ejaculation trailed behind.

This survey, conducted between April and July of 2026 and accepted for publication in Scientific Reports, matters because it upends a long-standing assumption in medicine: that men care most about erections. The researchers, examining what older men actually value, found something more textured. Arousal remained the priority across every age group tested—men in their 50s, 60s, 70s, and 80s all ranked it similarly. The desire to feel desire, it turns out, does not fade the way the body does.

But the body does fade, and it fades unevenly. Erectile function declined earliest, showing measurable loss or decline in roughly 5 to 7 percent of men in their 50s, climbing steadily until it affected nearly 44 percent of men aged 80 to 84. Yet something curious happened as erectile function worsened: men began to value it more. Among those whose erections remained intact, about 24 percent ranked it as their top priority. Among those who had lost erectile function entirely, that figure rose to nearly 29 percent. Loss sharpened desire for what was gone.

Ejaculation told a different story. It appeared later in the aging process but fell away more steeply. In men's 50s, only about 5 percent reported losing it. But after age 75, the decline accelerated sharply. By 80 to 84, more than half of men surveyed reported ejaculation as almost lost or completely lost—the highest rate of any sexual function measured. Yet men did not mourn its loss the way they mourned erectile decline. The importance they assigned to ejaculation did not shift based on whether they still had it.

Sexual arousal, by contrast, proved remarkably resilient. Even among the oldest men in the study, nearly 71 percent reported that arousal remained intact or had only declined somewhat. It was the function most often preserved. And crucially, men valued it equally whether they had it or not. Arousal mattered to them not because they feared losing it—though many did—but because it represented something fundamental about being alive in a sexual way.

Orgasm occupied a middle ground. As men lost the capacity for orgasm, they cared about it less. This inverse relationship—where loss breeds indifference—distinguished orgasm from arousal and erection. The researchers noted this pattern without explaining it, leaving the reader to wonder whether men rationalize loss by deciding it never mattered much, or whether orgasm itself is less central to sexual identity than the capacity to desire or to perform.

The study carries real weight for how doctors talk to patients about prostate cancer treatment. Nerve-sparing surgery has long been framed as a way to preserve erections. But if men care most about arousal, and if arousal is already the most resilient function, then the conversation between doctor and patient might shift. It might become less about saving erections and more about preserving the full texture of sexual life—desire, sensation, the feeling of being wanted and capable of wanting in return.

The researchers were careful to note the limits of their work. The men surveyed were not cancer patients making actual treatment decisions; they were internet-panel members imagining a hypothetical scenario. Their health status was not assessed. The survey asked about five domains with single questions, leaving room for different interpretations of what "arousal" or "fertility" actually meant to each respondent. These are real constraints on what the data can tell us.

Yet the finding stands: older men, when asked what they would most want to keep, chose the capacity to feel desire. Not the capacity to perform, not the capacity to father children, but the internal experience of wanting. It is a reminder that sexual health, for men as for anyone, extends far beyond the mechanics of the body—into the realm of feeling, of being alive to sensation and connection. The next question, for medicine and for men themselves, is what that knowledge changes.