Erectile Dysfunction

Content

• Erectile Dysfunction
• Definition
•  Causes
•  Pathophysiology
• Clinical Features

Objectives

At the end of this PDF Notes, students will be able to –

•       Define Erectile dysfunction

•       Explain the Pathophysiology of ED

•       Describe the clinical features of ED

Erectile Dysfunction (ED)

Erectile dysfunction is defined as “the failure to achieve a penile erection to allow for satisfactory sexual intercourse”

Patients may refer to it as impotence

Main Causes of Erectile Dysfunction

Etiology of Erectile Dysfunction

• Psychogenic
• Vasculogenic : – Cardiovascular disease – Hypertension – Diabetes mellitus – Major surgery or radiotherapy (pelvis or etroperitoneum).
• Neurogenic Central causes – Multiple sclerosis – Parkinson’s disease – Tumors – Stroke – Spinal cord disorders( disc disease ) Peripheral causes – Diabetes mellitus – Alcoholism – Polyneuropathy – Surgery (pelvis or retroperitoneum).
• Anatomical/structural – Peyronie’s disease – Penile fracture – Congenital curvature of the penis
• Hormonal – Hypogonadism – Hyperprolactinemia – Hyper-and hypothyroidism – Cushing’s disease.
• Drug-induced – Antihypertensives (beta-blocker, thiazide and clonidine .less with ACE inhibitors ) – Antidepressants (tricyclic antidepressants and MAO inhibitor) – Antipsychotics – Antiandrogens – Antihistamines – Recreational drugs (Heroin and cocaine)

How Does Erection Normally Happen?

Process of Erection

Pathophysiology of Erectile Dysfunction

Any single abnormality or combination of abnormalities of the four systems necessary for a normal penile erection

• Vascular, neurologic, or hormonal etiologies of erectile dysfunction are collectively referred to as organic erectile dysfunction

• Patients who do not respond to psychogenic stimuli have psychogenic erectile dysfunction

• Diseases that compromise vascular flow to the corpora cavernosum (e.g., peripheral vascular disease, arteriosclerosis, and essential hypertension) increases incidence of ED

• Diseases that impair nerve conduction to the brain (e.g., spinal cord injury or stroke) or conditions that impair peripheral nerve conduction to the penile vasculature

• Diseases associated with hypogonadism, primary or secondary, result in subphysiologic levels of testosterone, which cause diminished sexual drive (decreased libido) and secondary erectile dysfunction

• Vasoconstrictor effect of cigarette smoking may compromise blood flow to the corpora and decrease cavernosal filling

• Excessive ethanol intake may lead to androgen deficiency, peripheral neuropathy

Clinical Presentation of Erectile Dysfunction

Summary

•       Erectile dysfunction is defined as “the failure to achieve a penile erection to allow for satisfactory sexual intercourse”

•       It can occur due to various causes like psychogenic, vasculogenic and neurogenic

•       Failure to initiate psychogenic or neurogenic impulse or failure to increase arterial blood pressure may result in ED

•       ED may ultimately lead to impotence