| Sexual Health |
Erectile dysfunction
Many patients feel that erectile dysfunction is a normal consequence of aging. This is not true, although there are some
age-related changes that may affect sexual function. An example is a decrease in libido related to hypogonadism.
For the most part, sexual dysfunction is the result of the effects of age associated disease and/or their treatment on the
ability to develop or maintain an erection.
The etiology of erectile dysfunction may be broadly categorized as organic, psychogenic, or mixed. Organic causes may be
vascular, neurogenic, hormonal, or pharmacologic. They may be related to surgery or radiation. Organic disorders account
for the majority of all cases of erectile dysfunction.
Because adequate arterial blood supply is critical for erection, any disorder that affects blood flow may be a cause for
erectile dysfunction. Other disorders impair the ability to trap blood within the penis, or affect the neuronal pathways
involved in achieving and/or maintaining an erection. Hormonal and psychological factors may also play a role.
Most cases of erectile dysfunction are multifactorial in etiology, with organic and psychologic aspects. This requires a
multidisciplinary approach to assessment and treatment.
Erectile dysfunction is a widespread and under-reported disorder affecting millions of men. With the aging of our population
and the age-related comorbid conditions, this problem is only going to increase in magnitude.
The term "impotence," has traditionally been used to signify the inability of the male to attain and maintain erection of the
penis sufficient to permit satisfactory sexual intercourse.
However, this use has often led to confusing and un interpretable results in both clinical and basic science investigations.
This, together with its pejorative implications, suggests that the more precise term "erectile dysfunction" be used instead to
signify an inability of the male to achieve an erect penis as part of the overall multifaceted process of male sexual function.
What are the risk factors contributing to impotence?
Erectile Dysfunction
Because adequate arterial supply is critical for erection, any disorder that impairs blood flow may be implicated in the
etiology of erectile failure. Most of the medical disorders associated with erectile dysfunction appear to affect the arterial
system. Some disorders may interfere with the corporal veno-occlusive mechanism and result in failure to trap blood within
the penis, or produce leakage such that an erection cannot be maintained or is easily lost.
Damage to the autonomic pathways innervating the penis may eliminate "psychogenic" erection initiated by the central
nervous system. Lesions of the somatic nervous pathways may impair reflexogenic erections and may interrupt tactile
sensation needed to maintain psychogenic erections.
Spinal cord lesions may produce varying degrees of erectile failure depending on the location and completeness of the
lesions. Not only do traumatic lesions affect erectile ability, but disorders leading to peripheral neuropathy may impair
neuronal innervation of the penis or of the sensory afferents.
The endocrine system itself, particularly the production of androgens, appears to play a role in regulating sexual interest,
and may also play a role in erectile function.
Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning by reducing
erotic focus or otherwise reducing awareness of sensory experience. This may lead to inability to initiate or maintain an
erection.
Etiologic factors for erectile disorders may be categorized as neurogenic, vasculogenic, or psychogenic, but they most
commonly appear to derive from problems in all three areas acting in concert.
Because of the difficulty in defining the clinical entity of erectile dysfunction, there have been a variety of entry criteria for
patients in therapeutic trials. Similarly, the ability to assess efficacy of therapeutic interventions is impaired by the lack of
clear and quantifiable criteria of erectile dysfunction.
Many patients feel that erectile dysfunction is a normal consequence of aging. This is not true, although there are some
age-related changes that may affect sexual function. An example is a decrease in libido related to hypogonadism.
For the most part, sexual dysfunction is the result of the effects of age associated disease and/or their treatment on the
ability to develop or maintain an erection.
The etiology of erectile dysfunction may be broadly categorized as organic, psychogenic, or mixed. Organic causes may be
vascular, neurogenic, hormonal, or pharmacologic. They may be related to surgery or radiation. Organic disorders account
for the majority of all cases of erectile dysfunction.
Because adequate arterial blood supply is critical for erection, any disorder that affects blood flow may be a cause for
erectile dysfunction. Other disorders impair the ability to trap blood within the penis, or affect the neuronal pathways
involved in achieving and/or maintaining an erection. Hormonal and psychological factors may also play a role.
Most cases of erectile dysfunction are multifactorial in etiology, with organic and psychologic aspects. This requires a
multidisciplinary approach to assessment and treatment.
Erectile dysfunction is a widespread and under-reported disorder affecting millions of men. With the aging of our population
and the age-related comorbid conditions, this problem is only going to increase in magnitude.
The term "impotence," has traditionally been used to signify the inability of the male to attain and maintain erection of the
penis sufficient to permit satisfactory sexual intercourse.
However, this use has often led to confusing and un interpretable results in both clinical and basic science investigations.
This, together with its pejorative implications, suggests that the more precise term "erectile dysfunction" be used instead to
signify an inability of the male to achieve an erect penis as part of the overall multifaceted process of male sexual function.
What are the risk factors contributing to impotence?
Erectile Dysfunction
Because adequate arterial supply is critical for erection, any disorder that impairs blood flow may be implicated in the
etiology of erectile failure. Most of the medical disorders associated with erectile dysfunction appear to affect the arterial
system. Some disorders may interfere with the corporal veno-occlusive mechanism and result in failure to trap blood within
the penis, or produce leakage such that an erection cannot be maintained or is easily lost.
Damage to the autonomic pathways innervating the penis may eliminate "psychogenic" erection initiated by the central
nervous system. Lesions of the somatic nervous pathways may impair reflexogenic erections and may interrupt tactile
sensation needed to maintain psychogenic erections.
Spinal cord lesions may produce varying degrees of erectile failure depending on the location and completeness of the
lesions. Not only do traumatic lesions affect erectile ability, but disorders leading to peripheral neuropathy may impair
neuronal innervation of the penis or of the sensory afferents.
The endocrine system itself, particularly the production of androgens, appears to play a role in regulating sexual interest,
and may also play a role in erectile function.
Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning by reducing
erotic focus or otherwise reducing awareness of sensory experience. This may lead to inability to initiate or maintain an
erection.
Etiologic factors for erectile disorders may be categorized as neurogenic, vasculogenic, or psychogenic, but they most
commonly appear to derive from problems in all three areas acting in concert.
Because of the difficulty in defining the clinical entity of erectile dysfunction, there have been a variety of entry criteria for
patients in therapeutic trials. Similarly, the ability to assess efficacy of therapeutic interventions is impaired by the lack of
clear and quantifiable criteria of erectile dysfunction.
Normal male sexual function
involves 3 phases:
involves 3 phases:
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