Erectile dysfunction

Abstract

Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man’s quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner’s sexual experience and the couple’s quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.

Is milder psychological stress responsible for more severe erectile dysfunction?

“…In the past, ED was considered to be a purely or primarily psychological symptom in most cases (Aghighi, Grigoryan, & Delavar, 2015; Bivalacqua, Champion, Hellstrom, & Kadowitz, 2000; Papagiannopoulos, Khare, & Nehra, 2015). With more research and more advanced diagnostic approaches (Tang, Tang, Dai, Lu, & Jiang, 2013; Tang et al, 2009), the current evidence suggests that potential organic risk factors or aetiologies were determined in more than 80% of cases (Yafi et al, 2016). Erectile dysfunction is most often a complex disorder associated with multivariable factors that can be classified as psychogenic, organic, or mixed psychogenic and organic.…”

Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension

“…This association could be explained because of the altered haemodynamic state in splanchnic circulation in patients with portal hypertension. Since non‐endocrine vasculogenic disorders can cause ED and this is attributed to either arterial inflow or venous outflow disorders, one could argue that these haemodynamic alterations directly impair physiological penile erection. Previous studies found conflicting results with regard to the impact of chronic liver disease (CLD)/cirrhosis on prevalence and severity of ED.…”

“…Erectile dysfunction (ED) is defined as the inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual intercourse . Erectile dysfunction itself is an established determinant of HRQOL in men . The reported prevalence of ED ranges between 5% and 50% in the general population and is related to age, overall health status and emotional function .…”

“…Erectile dysfunction itself is an established determinant of HRQOL in men . The reported prevalence of ED ranges between 5% and 50% in the general population and is related to age, overall health status and emotional function . Multiple endocrine (hypogonadism) and non‐endocrine (vasculogenic, neurogenic and iatrogenic) abnormalities may contribute to the pathogenesis of ED .…”

Small fibre pathology is associated with erectile dysfunction in men with type 2 diabetes

“…[2][3][4] ED is also a marker of cardiovascular disease and has been associated with poorer generic and disease-specific quality of life among men with both type 1 (T1D) and type 2 diabetes (T2D). [5][6][7] Organic, relational, and psychological factors contribute to ED and include neurogenic, vasculogenic, iatrogenic, and endocrine pathways, 8,9 which mediate penile endothelial dysfunction and defective noradrenergic and cholinergic nerve signalling with increased cavernosal contractile sensitivity and impaired dilatory function. 10 Vascular abnormalities including penile smooth muscle and endothelial dysfunction and altered cavernosal haemodynamics have been considered to play a major role in diabetes related ED, 11 whilst the impact of neuropathy has been underestimated.…”