ESSENTIAL OF DIAGNOSIS
- Erectile dysfunction can have organic and psychogenic etiologies, and the two frequently overlap
- Organic erectile dysfunction may be an early sign of cardiovascular disease and requires evaluation.
- Peyronie disease is a common fibrotic disorder of the corpora cavernosa of the penis that causes pain, penile deformity, and sexual dysfunction.
General Considerations Erectile dysfunction is the consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance.
Normal male erection is a neurovascular event relying on an intact autonomic and somatic nerve supply to the penis, smooth and striated musculature of the corpora cavernosa and pelvic floor, and arterial blood flow supplied by the paired pudendal arteries.
Erection is caused and maintained by an increase in arterial flow, active relaxation of the smooth muscle within the sinusoids of the paired corpora cavernosa of the penis, and an increase in venous resistance.
Contraction of the bulbocavernosus and ischiocavernosus muscles results in further rigidity of the penis with intracavernosal pressures exceeding systolic blood pressure.
Nitric oxide is a key neurotransmitter that initiates and sustains erections, however,other molecules contribute,including acetylcholine,prostaglandins,and vasoactive intestinal peptide.
Male sexual dysfunction may be manifested in a variety of ways, and patient history is critical to the proper classification and treatment.
A loss of libido may indicate androgen deficiency
Loss of erections may result from arterial, venous, neurogenic, hormonal, or psychogenic causes.
Concurrent medical problems may damage one or more of the mechanisms.
Endothelial dysfunction is the decreased bioavailability of nitric oxide with subsequent impairment of arterial vasodilation, Erectile dysfunction may be an early manifestation of endothelial dysfunction. which precedes more severe atherosclerotic cardiovascular disease.
Many medications, especially antihypertensive, antidepressant, and opioid agents, are associated with Erectile dysfunction.
Peyronie disease – a fibrotic disorder of tunica albuginea of the penis resulting in varying degrees of penile curvature or deformity.
Priapism- is the occurrence of penile erection unrelated to sexual stimulation lasting longer than 4 hours that potentially causes ischemic injury. Priapism may because of drug use, and any treatment of erectile dysfunction.
Retrograde ejaculation -may occur as a result of mechanical disruption of the bladder neck due to transurethral resection of prostate.pelvic radiation, sympathetic denervation or the treatment of the Alpha Blockers
Premature ejaculation- is persistent or recurrent ejaculation with minimal stimulation before a person desire .it may primary or secondary dysfunction.