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 inihibitor) - Antipsychotics - Antiandrogens - Antihistamines - Recreational drugs (Heroin and cocaine)

How Dose 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