ORIGINAL RESEARCH—PATHOPHYSIOLOGYPathophysiology of Erectile Dysfunction
Section snippets
Neurogenic Erectile Dysfunction
Events that disrupt central neural networks or the peripheral nerves involved in sexual function can cause ED. This form of ED has been termed “neurogenic impotence.” It has been estimated that 10–19% of ED is of neurogenic origin [1, 2].
The etiologies of neurogenic ED can be classified as:
Peripheral (peripheral ED)
Spinal (sacral‐peripheral ED, suprasacral‐central ED)
Supraspinal (suprasacral ED)
Peripheral ED can be secondary to the disruption of sensory nerves that bring local information to
Vascular Erectile Dysfunction
Erectile dysfunction and cardiovascular disease share the same risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, and smoking [20, 21]. This led to the suggestion that ED is another manifestation of vascular disease [22, 23].
Diabetes
There is good epidemiological evidence of a causal link between diabetes and ED [70]. The prevalence of ED is three times higher in diabetic men (28% vs. 9.6%) [21], occurs at an earlier age, and increases with disease duration, being approximately 15% at age 30 rising to 55% at 60 years [71, 72].
Diabetes mellitus may cause ED through a number of pathophysiological changes affecting psychological function, central nervous system (CNS) function, androgen secretion, peripheral nerve activity,
Primary Erectile Dysfunction
Physical causes of primary ED are likely to relate to maldevelopment of the corpora or their blood and nerve supply. In addition, vascular or neurological damage may occur during fetal life or childhood. Primary psychological dysfunction can also occur and is usually related to anxiety about sexual performance stemming from adverse childhood events or traumatic early sexual experience. Endocrine abnormalities, particularly low testosterone levels, may also be implicated in primary ED although
Chronic Renal Failure and Erectile Dysfunction
Men suffering chronic renal failure (CRF) requiring renal replacement therapy have a high prevalence of sexual dysfunction (20–50%) [96]. A recent well‐performed cross‐sectional study demonstrated a prevalence of severe self‐reported ED among men on hemodialysis of 45%[97]. The risk was increased by older age, diabetes, and nonuse of ACE inhibitors. Many of the pathophysiological effects of persistent uremia can potentially contribute to the development of ED including disturbance of the
Drugs Causing Erectile Dysfunction
In order to confidently establish a causative relationship, three conditions should be satisfied. There should be a higher prevalence of ED among men taking the drug calculated from data with placebo control and stratification for known risk factors of ED. A greater prevalence of ED should also be found for the target drug compared to another drug with an equivalent therapeutic effect using data from a randomized controlled trial, again with allowance for confounding variables. Finally, a
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