Review of Erectile Dysfunction

Section I:A Review of Erectile Dysfunction

Introduction 3

Anatomy 4

Arterial blood supply 4

Venous drainage 4

Lymphatic drainage 5

Neuroanatomy 5

Central nervous system connections 5

Mechanisms of erection 6

Regulation of intracavernosal smooth muscle contractility 6

Adrenergic vasoconstrictor mechanisms 7

Cholinergic mechanisms 7

Non-adrenergic non-cholinergic mechanisms 7

Endothelial mechanisms 7

Hemodynamics of erection 7

Orgasm and ejaculation 8

Pathophysiology of erectile dysfunction 9

Vasculogenic causes 9

Neurogenic causes 10

Endocrinological causes 11

Priapism and postpriapism erectile dysfunction 12

Psychogenic causes 12

Epidemiology of erectile dysfunction 13

Risk factors for erectile dysfunction 14

Diabetes mellitus 14

Hypertension 14

Hyperlipidemia 14

Smoking 14

Peyronie's disease 14

Previous surgery 15

Depression 15

Diagnosis of erectile dysfunction 16

History 16

Physical examination 17

Special investigations 17

Treatment options for erectile dysfunction 19

Psychosexual counseling 19

Medical therapies 19

Vacuum devices 22

Surgical therapies 22

Conclusions 24

Bibliography 25

Appendix 28

2

Introduction

Until recently, a man unable to develop or sustain an erection sufficient for
penetrative sexual intercourse has been referred toas 'impotent'. This term,
however, has negative connotations which imply a general loss of prowess in
other domains ofmental and physical function. Thus, nowadays, the more
specific term 'erectile dysfunction' is preferred.

Although the problem is most commonly the result of isolated malfunction of
penile erection, diminished or absent libidoand delayed or absent orgasm and
ejaculation frequently coexist with erectile dysfunction, each in its own way
contributing tothe afflicted individual's sense of failure and personal
inadequacy.

Many millions of men world-wide are afflicted by erectile dysfunction.
Although the ability to develop and sustain anerection may not always result
in complete loss of sexual satisfaction, in most men, it creates a psychological
stress thatadversely affects the relationship with their partner. This, in
itself; often compounds the physical problem. In men of all ages;erectile
dysfunction diminishes the willingness to initiate or continue sexual
relationships, not only because of loss of self-esteem, but also because of
the fear of the humiliation associated with inadequate sexual performance and
the risk ofsubsequent rejection.

Erectile dysfunction is frequently regarded as an inevitable part of aging
and, thus, as a symptom simply to be acceptedwith stoicism. However; this
assumption is often incorrect. Erectile dysfunction is not uncommonly the result
of some otherillness, such as diabetes mellitus or hypertension, or a
consequence of the treatment of the latter disorder withantihypertensive
agents.

The correct diagnosis of erectile dysfunction depends on an accurate and
sympathetically elicited history which recognizesthat the physical component
may be only part of the problem. The psychological, interpersonal and wider
social ramificationsalso need to be tactfully assessed. Careful physical
examination and judicious stepwise use of investigations help to completethe
picture.

Now, for the first time; an increasing range of safe and effective treatment
options is available for men who suffer fromerectile dysfunction. Many of
these options, however, are poorly appreciated not only by patients; but also by
health-careprofessionals, many of whom still feel too embarrassed to address
this highly prevalent and distressing problem in a seriousand sympathetic
manner.

Erectile dysfunction often has a major impact on the self—esteem and quality
of life not only of the man, but also of hispartner. Thus, there are few
areas in medicine where so much remains to be done and with so much potential to
improve theoutlook for the many millions of sufferers as well as for their
partners.