Neurogenic erectile dysfunction

Abstract

Penile erection is a neurovascular event modulated by psyche and hormones. Erectile dysfunction (ED) has been classified as psychogenic, arteriogenic, neurogenic, endocrinologic, and cavernosal, based on the organs that are involved in penile erection. Among these types, neurogenic ED may be the most common, probably because a deficiency of neurotransmitters is the final common pathway in many diseases and conditions. This review discusses the physiology, pathophysiology, diagnosis, and treatment of erectile function and dysfunction, as well as strategies for future research.

Effect of icarisid II on diabetic rats with erectile dysfunction and its potential mechanism via assessment of AGEs, autophagy, mTOR and the NO–cGMP pathway

“…34 Corpus cavernosum SMC fibrosis and cavernous nerve damage occurs in nearly 70% of diabetic patients. 35,36 In such patients, treatment with existing drugs is almost always ineffectual because drugs such as PDE5 inhibitors require the presence of intact and undamaged penile nerves and SMCs. Therefore, there is a great need for a new compound that has the capacity to help regenerate damaged nerves and SMCs.…”

Treating Erectile Dysfunction and Central Neurological Diseases with Oral Phosphodiesterase Type 5 Inhibitors. Review of the Literature

“…The reasons may be multiple and diverse according to the neurological disease. Essentially, ED may depend on the interaction of many factors on CND [1,6,7,13]. An intriguing fact is that the majority of SCI patients suffer the onset of ED at the time of SCI (primary effect) and, therefore, the use of oral PDE5 is appropriate.…”

“…Neurogenic erectile dysfunction may be defined as the inability to obtain and maintain a penile erection due to neurological impairment, which may have its origin in the central nervous system (spinal and/or sopraspinal network) or in the peripheral neural pathways. There are three different segments in the spinal cord correlated to erectile function: the sympathetic (level T10‐L2) responsible for psychogenic erection, parasympathetic (level S2‐S4) fundamental for reflexogenic erection, and somatic (S2‐S4) situated in the Onuf's nucleus where the nerves originate and which innervate the ischiocavernous and bulbocavernous muscles needed for penile sensation and the rigid phase of erection [1]. In the last decade, positron emission tomography scanners and functional magnetic resonance imaging have been used to evaluate the modification of brain activity during sexual excitement and penile erection [2–5].…”

“…Literature reports that sustained erection is correlated to increased activity in the secondary somatosensory and temporal cortex, in the inferior frontal gyrus, the insula, the anterior cingulatem, and the medial nucleo of the amygdala [6]. Erection is also accompanied by elevated activity in the hypothalamus, mainly in the paraventricular nucleo and the medial preoptic area [1–6]. Central nervous diseases (CND), linked to erectile dysfunction (ED), may be due not only to the singular damage of a specific central area (such as the temporal lobe, substantia nigra) involved in erectile function, but also because this injury may lead to a communication block between different central structures and/or afferent and efferent pathways [1,6,7].…”

“…Erection is also accompanied by elevated activity in the hypothalamus, mainly in the paraventricular nucleo and the medial preoptic area [1–6]. Central nervous diseases (CND), linked to erectile dysfunction (ED), may be due not only to the singular damage of a specific central area (such as the temporal lobe, substantia nigra) involved in erectile function, but also because this injury may lead to a communication block between different central structures and/or afferent and efferent pathways [1,6,7]. These structures and healthy sexuality are also influenced by steroid hormones, neurochemical regulations, neurotransmitters, the monoamin system, opioids, gamma‐aminobutyric acid (GABA), and neuroendocrine hormones (oxytocin, prolactin, gonadotropon realizing hormone) [1,6,7].…”