Aging and pathogenesis of erectile dysfunction

Abstract

The prevalence and the severity of erectile dysfunction (ED) increase with advancing age; different pathogenetic factors could contribute to age-related ED. We studied organic, relational and intrapsychic components of ED as a function of patients' age in a consecutive series of 977 patients with ED, using the specifically designed structured interview SIEDY r . A complete physical examination and a series of biochemical, hormonal, psychometric and penile vascular tests were also performed. Relational factors seems to be more relevant in patients aged over 60 y, while intrapsychic disturbances play a major role in younger subjects. Organic factors are the most important determinant of ED in all age groups, but their contribution is more important in older patients. In fact, basal and dynamic peak cavernosal velocity at Doppler ultrasound penile examination was reduced in older patients. Among hormonal factors, the body mass indexdependent reduction of testosterone in older patients does not seem to play a crucial role in the pathogenesis of ED. No significant correlation was observed between testosterone level and the severity of ED, although patients reporting hypoactive sexual desire showed significantly lower testosterone levels when compared with the rest of the sample. A better understanding of the relative contribution of age-related pathogenetic factors of ED could be of help in the design of appropriate therapeutic approaches.

Psychobiological correlates of smoking in patients with erectile dysfunction

“…Interestingly, in our, as well as in other, reports, 32,40 the negative effect of smoking cessation on HPT was independent of tobacco-withdrawalinduced weight gain, which per se could substantially contribute to the aging-related T decline. [41][42][43] In fact, T decline after smoking cessation retains significance even after correction for confounding factors, as age and BMI. However, BMI plays an independent and crucial role in the control of testosterone plasma levels; in fact in our study BMI was the only parameter significantly correlated to each smoking group even after adjustment for confounding factors.…”

“…This is in accordance with previous reports showing that BMI is the best predictor of testosterone plasma level decline with age. 41,43 On the other hand, it is possible that the smoking habit acts as a potential confounder in cross-sectional studies on T, because smoking, as a part of risky behaviour, is initiated more often in sensational seekers, which are characterized by higher androgen levels. [44][45][46] Cigarette smoking is indeed a socially accepted addictive disorder 47 often present in sensational seekers.…”

“…[42][43][44][45][46] Cross-sectional surveys, such as this one, do not allow any conclusion on the direction of causal relationships. However, it is notable that PS show LH, testosterone and testicular volume similar to those of never smokers, suggesting that cigarette smoking stimulates HPT axis activity, and that the effect is lost with smoking cessation.…”

Smoking and sexual dysfunction in Chinese males: findings from men's health survey

“…Many different factors were suggested as contributing factors for age-related ED. 22 These include organic, relational and intrapsychic components.…”

Sexual dysfunction in the older man

“…While the role of disease states cannot be overlooked, it is important to recall that psychogenic, situational and relational factors play a major role in the pathogenesis of ED in men of all ages and deserve consideration. 32 Even in cases where a primary organic aetiology is identified, contextual and psychological factors will contribute to the overall disease state of ED in virtually every case.…”