Therapies initiated by urologists, medical as well as surgical, may cause adverse effects in different sexual domains. Sexual domains that are often affected are sexual interest, sexual activity, and erectile functioning. As many elderly men undergo these therapies, it is important to know the prevalence of sexual dysfunction (SD) in these domains and its impact in the healthy elderly male population. This may help healthcare providers counsel their patients properly on possible adverse effects. To review the prevalence of sexual functioning and SD in the domains of sexual desire, sexual activity, and erectile dysfunction (ED) and its impact (bother and medical use), stratified by age. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Studies investigating the prevalence of SD, stratified by age, were eligible. Studies investigating bother due to ED, and studies evaluating medical use or use of medical professional healthcare providers in association with SD were eligible. A total of 76 articles were eligible for a full systematic review. Lack of sexual desire was reported to vary between 12% and 51.6% for men aged ≥60 yr, 20% and 65.9% for men aged ≥70 yr, and 40% and 82.4% for men aged ≥80 yr. The percentages of men bothered by ED were as follows: 14.3-70% for men aged ≥60 yr, 6.7-48% for men aged ≥70 yr, and 38% for men aged ≥80 yr. A substantial number of men (50.3-92%) find a normal sex life important as they age and remain sexually active. Only a minority of elderly men seek help from healthcare professionals or use medication for SD. The prevalence of SD in the healthy male population, reflected by a loss of sexual desire and sexual activity, increases only slightly with age. Bother due to ED is relatively low and there is an association with age. Still, a large number of men in the middle-aged and elderly groups regard sexuality as an important aspect of life. While considering a surgical or medical therapy that could have an impact on sexual functioning, sexually related outcomes should be set against current sexual functioning and a probable decline of sexual functioning due to ageing. While counselling elderly patients for sexual dysfunction when starting a treatment that could have an influence on sexual functioning, one should consider current sexual functioning and its importance for the individual. Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.