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Physiology of Erection and Causes of Erectile Dysfunction

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Heart Disease and Erectile Dysfunction

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Erectile dysfunction (ED), defined as “the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance” (1), is a highly prevalent condition. It is estimated that currently approximately 30 million men in the United States are affected (2). This number is expected to at least double by 2025 as a result of the aging of the male population as well as increased awareness of the problem (3). ED can have emotional, physical, and iatrogenic causes. Mixed forms are common, and ED may also be a symptom of chronic diseases.

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References

  1. NIH Consensus Development Panel on Impotence. NIH Consensus Conference: Impotence. JAMA 1992; 270: 83–90.

    Google Scholar 

  2. Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North Am 1995; 22: 699–709.

    PubMed  CAS  Google Scholar 

  3. Aytac IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999; 84: 50–56.

    Article  Google Scholar 

  4. Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction and priapism. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell Urology, 8th ed., vol. 2, Saunders, Philadelphia, 2002, pp. 1591–1618.

    Google Scholar 

  5. Saenz de Tejada I. Anatomy, physiology, and pathophysiology of ED. In: Jardin A, Wagner G, Khoury S, eds. Erectile Dysfunction. 5th ed., Plymbridge Distributors, Plymouth, UK, 2000, pp. 65–102.

    Google Scholar 

  6. Goldstein I, and the Working Group for the Study of Central Mechanisms in Erectile Dysfunction. Male sexual circuitry. Sci Am 2000; 283: 70–75.

    Article  PubMed  CAS  Google Scholar 

  7. Breza J, Aboseif SR, Orvis BR, et al. Detailed anatomy of penile neurovascular structures: surgical significance. J Urol 1989; 141: 437–443.

    PubMed  CAS  Google Scholar 

  8. Lue TF. Erectile dysfunction. N Engl J Med 2000; 342: 1802–1813.

    Article  PubMed  CAS  Google Scholar 

  9. Rajfer J, Aronson WJ, Bush PA, et al. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med 1992; 326: 90–94.

    Article  PubMed  CAS  Google Scholar 

  10. Cox JD, Kim NN, Traish AM, et al. Arginase-boronic acid complex highlights a physiological role in erectile function. Nat Struct Biol 1999; 6: 1043–1047.

    Article  PubMed  CAS  Google Scholar 

  11. Bivalacqua TJ, Hellstrom WJ, Kadowitz PJ, et al. Increased expression of arginase II in human diabetic corpus cavernosum: in diabetic-associated erectile dysfunction. Biochem Biophys Res Commun 2001; 283: 923–927.

    Article  PubMed  CAS  Google Scholar 

  12. Chitaley K, Wingard CJ, Clinton Webb R, et al. Antagonism of Rho-kinase stimulates rat penile erection via a nitric oxide-independent pathway. Nat Med 2001; 7: 119–122.

    Article  PubMed  CAS  Google Scholar 

  13. Mills TM, Chitaley K, Wingard CJ, et al. Effect of Rho-kinase inhibition on vasoconstriction in the penile circulation. J Appl Physiol 2001; 91: 1269–1273.

    PubMed  CAS  Google Scholar 

  14. Araujo AB, Durante R, Feldman HA, et al. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998; 60: 458–465.

    PubMed  CAS  Google Scholar 

  15. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    PubMed  CAS  Google Scholar 

  16. Chun J, Carson CC. Physician-patient dialogue and clinical evaluation of erectile dysfunction. Urol Clin North Am 2001; 28: 249–258.

    Article  PubMed  CAS  Google Scholar 

  17. Burchardt M, Burchardt T, Anastasiadis AG, et al. Erectile dysfunction is a marker for cardiovascular complications and psychological functioning in men with hypertension. Int J Impot Res 2001; 13: 276–281.

    Article  PubMed  CAS  Google Scholar 

  18. Seidman SN, Roose SP, Menza MA, et al. Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–1630.

    Article  PubMed  CAS  Google Scholar 

  19. Tiefer L, Schuetz-Mueller D. Psychological issues in diagnosis and treatment of erectile disorders. Urol Clin North Am 1995; 22: 767–773.

    PubMed  CAS  Google Scholar 

  20. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    Article  PubMed  CAS  Google Scholar 

  21. Usta MF, Erdogru T, Tefekli A, et al. Honeymoon impotence: psychogenic or organic in origin? Urology 2001; 57: 758–762.

    Article  PubMed  CAS  Google Scholar 

  22. Araujo AB, Johannes CB, Feldman HA, et al. Relation between psychosocial risk factors and incident erectile dysfunction: prospective results from the Massachusetts Male Aging Study. Am J Epidemiol 2000; 152: 533–541.

    Article  PubMed  CAS  Google Scholar 

  23. Lewis RW, Hatzichristou DG, Laumann E, et al. Epidemiology and natural history of erectile dysfunction; risk factors including iatrogenic and aging. In: Jardin A, Wagner AH, Khoury S, Giuliano F, Padma-Nathan H, Rosen M, eds. Erectile Dysfunction, Health Publication Ltd, Plymouth, 2000, pp. 21–51.

    Google Scholar 

  24. Verbeuren TJ, Jordaens FH, Zonnekeyn LL, et al. Effect of hypercholesterolemia on vascular reactivity in the rabbit. I. Endothelium-dependent and endothelium-independent contractions and relaxations in isolated arteries of control and hypercholesterolemic rabbits. Circ Res 1986; 58: 552–564.

    Article  PubMed  CAS  Google Scholar 

  25. Kim JH, Klyachkin ML, Svendsen E, et al. Experimental hypercholesterolemia in rabbit induces cavernosal atherosclerosis with endothelial and smooth muscle cell dysfunction. J Urol 1994; 151: 198–205.

    PubMed  CAS  Google Scholar 

  26. Behr-Roussel D, Bernabe J, Compagnie S, et al. Distinct mechanisms implicated in atherosclerosis-induced erectile dysfunction in rabbits. Atherosclerosis 2002; 162: 355–362.

    Article  PubMed  CAS  Google Scholar 

  27. De Angelis L, Marfella MA, Siniscalchi M, et al. Erectile and endothelial dysfunction in Type II diabetes: a possible link. Diabetologia 2001; 44: 1155–1160.

    Article  PubMed  Google Scholar 

  28. Azadzoi KM, Saenz de Tejada I. Hypercholesterolemia impairs endothelium-dependent relaxation of rabbit corpus cavernosum smooth muscle. J. Urol 1991; 146: 238–240.

    PubMed  CAS  Google Scholar 

  29. Taddei S, Virdis A, Mattei P, et al. Aging and endothelial function in normotensive subjects and patients with essential hypertension. Circulation 1995; 91: 1981–1987.

    Article  PubMed  CAS  Google Scholar 

  30. Mc Vary K, Carrier S, Wessells H, and the Subcommittee on Smoking and Erectile Dysfunction Socioeconomic Committee, Sexual Medicine Society of North America. Smoking and erectile dysfunction: evidence-based analysis. J Urol 2001; 166: 1624–1632.

    Article  Google Scholar 

  31. DePalma RG, Schwab F, Druy EM, et al. Experience in diagnosis and treatment of impotence caused by cavernosal leak syndrome. J Vasc Surg 1989; 10: 117–121.

    PubMed  CAS  Google Scholar 

  32. Munarriz RM, Yan QR, Nehra A, et al. Blunt trauma: the pathophysiology of hemodynamic injury leading to erectile dysfunction. J Urol 1995; 153: 1831–1840.

    Article  PubMed  CAS  Google Scholar 

  33. Marceau L, Kleinman K, Goldstein I, et al. Does bicycling contribute to the risk of erectile dysfunction? Results from the Massachusetts Male Aging Study (MMAS). Int J Impot Res 2001; 13: 298–302.

    Article  PubMed  CAS  Google Scholar 

  34. Sommer F, Schwarzer U, Klotz T, et al. Erectile dysfunction in cyclists. Is there any difference in penile blood flow during cycling in an upright versus a reclining position? Eur Urol 2001; 39: 720–723.

    Article  PubMed  CAS  Google Scholar 

  35. Rao DS, Donatucci CF. Vasculogenic impotence. Arterial and venous surgery. Urol Clin North Am 2001; 28: 309–319.

    Article  PubMed  CAS  Google Scholar 

  36. Nehra A, Moreland RB. Neurologic erectile dysfunction. Urol Clin North Am 2001; 28: 289–308.

    Article  PubMed  CAS  Google Scholar 

  37. Burchardt T, Burchardt M, Karden J, et al. Reduction of endothelial and smooth muscle density in the corpora cavernosa of the streptozotocin induced diabetic rat. J Urol 2000; 164: 1807–1811.

    Article  PubMed  CAS  Google Scholar 

  38. Moreland RB. Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res 1998; 10: 113–120.

    Article  PubMed  CAS  Google Scholar 

  39. Jiaan DB, Seftel AD, Fogarty J, et al. Age-related increase in an advanced glycation end product in penile tissue. World J Urol 1995; 13: 369–375.

    Article  PubMed  CAS  Google Scholar 

  40. Siegel T, Moul JW, Spevak M, et al. The development of erectile dysfunction in men treated for prostate cancer. J Urol 2001; 165: 430–435.

    Article  PubMed  CAS  Google Scholar 

  41. Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000; 283: 354–360.

    Article  PubMed  CAS  Google Scholar 

  42. Wallen K. Sex and context: hormones and primate sexual motivation. Horm Behav 2001; 40: 339–357.

    Article  PubMed  CAS  Google Scholar 

  43. Bagatell CJ, Heiman JR, Rivier JE, et al. Effects of endogenous testosterone and estradiol on sexual behavior in normal young men. J Clin Endocrinol Metab 1994; 78: 711–716.

    Article  PubMed  CAS  Google Scholar 

  44. Shabsigh R, Raymond JF, Olsson CA, et al. Androgen induction of DNA synthesis in the rat penis. Urology 1998; 52: 723–728.

    Article  PubMed  CAS  Google Scholar 

  45. Korenman SG, Morley JE, Mooradian AD, et al. Secondary hypogonadism in older men: its relation to impotence. J Clin Endocrinol Metab 1990; 71: 963–969.

    Article  PubMed  CAS  Google Scholar 

  46. Bhasin S. The dose-dependent effects of testosterone on sexual function and on muscle mass and function. Mayo Clin Proc 2000; 75 (Suppl): S70–S76.

    PubMed  CAS  Google Scholar 

  47. Carani C, Scuteri A, Marrama P, et al. The effects of testosterone administration and visual erotic stimuli on nocturnal penile tumescence in normal men. Horm Behav 1990; 24: 435–441.

    Article  PubMed  CAS  Google Scholar 

  48. Wang C, Swedloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel Study Group. J Clin Endocrinol Metab 2000; 85: 2839–2853.

    Article  PubMed  CAS  Google Scholar 

  49. Finger WW, Lund M, Slagle MA. Medications that may contribute to sexual disorders. A guide to assessment and treatment in family practice. J Fam Pract 1997; 44: 33–43.

    PubMed  CAS  Google Scholar 

  50. Ralph D, McNicholas T. UK management guidelines for erectile dysfunction. BMJ 2000; 321: 499–503.

    Article  PubMed  CAS  Google Scholar 

  51. Chatterjee R, Andrews HO, McGarrigle HH, et al. Cavernosal arterial insufficiency is a major component of erectile dysfunction in some recipients of high-dose chemotherapy/chemo-radiotherapy for haematological malignancies. Bone Marrow Transplant 2000; 25: 1185–1189.

    Article  PubMed  CAS  Google Scholar 

  52. Rosen RC. Psychogenic erectile dysfunction. Urol Clin N Am 2001; 28: 269–278.

    Article  CAS  Google Scholar 

  53. Nurnberg HG, Seidman SN, Gelenberg AJ, et al. Depression, antidepressant therapies, and erectile dysfunction: clinical trials of sildenafil citrate (Viagra) in treated and untreated patients with depression. Urology 2002; 60: 58–66.

    Article  PubMed  Google Scholar 

  54. Shabsigh R, Klein LT, Seidman S, et al. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 1998; 52: 848–852.

    Article  PubMed  CAS  Google Scholar 

  55. Nofzinger EA, Thase ME, Reynolds CF 3rd, et al. Sexual function in depressed men. Assessment by self-report, behavioral, and nocturnal penile tumescence measures before and after treatment with cognitive behavior therapy. Arch Gen Psychiatry 1993; 50: 24–30.

    Article  PubMed  CAS  Google Scholar 

  56. Ford DE, Mead LA, Chang PP, et al. Depression is a risk factor for coronary artery disease in men: the precursors study. Arch Intern Med 1998; 158: 1422–1426.

    Article  PubMed  CAS  Google Scholar 

  57. Keene LC, Davies PH. Drug-related erectile dysfunction. Adverse Drug React Toxicol Rev 1999; 181: 5–24.

    Google Scholar 

  58. Bancroft J. Central inhibition of sexual response in the male: a theoretical perspective. Neurosci Biobehav Rev 1999; 23: 764–784.

    Article  Google Scholar 

  59. Shabsigh R, Anastasiades A. Erectile dysfunction. Ann Rev Med 2003; 54: 153–168.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Aristotelis G. Anastasiadis MD
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  2. Dmitry Droggin MD
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  3. Martin Burchardt MD
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  4. Ridwan Shabsigh MD
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Editor information

Editors and Affiliations

  1. The Heart Institute, Good Samaritan Hospital, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Robert A. Kloner MD, PhD

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© 2004 Humana Press Inc., Totowa, NJ

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Anastasiadis, A.G., Droggin, D., Burchardt, M., Shabsigh, R. (2004). Physiology of Erection and Causes of Erectile Dysfunction. In: Kloner, R.A. (eds) Heart Disease and Erectile Dysfunction. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-748-2_1

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  • DOI: https://doi.org/10.1007/978-1-59259-748-2_1

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9849-3

  • Online ISBN: 978-1-59259-748-2

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