Erectile Dysfunction: Pathogenesis
Abbreviations: • CBC – Complete Blood Count • cGMP – cyclic Guanosine Mono-Phosphate • CVD – Cardiovascular Disease • HbA1c – Hemoglobin A1c • mm-millimeter • NO – Nitric Oxide
Organic Erectile Dysfunction
Gradual, all circumstances, older, nocturnal/AM erection absent
Mixed Psychogenic and Organic Erectile Dysfunction
Vasculogenic Erectile Dysfunction
Hypertension, smoking, hyperlipidemia, diabetes, cardiovascular disease, iatrogenic
Endothelia cell damage and I` small vessel disease (penile artery diameter 1-2 mm)
1. Assess CVD Disease risk* a. I% Blood pressure b. I% Fasting glucose or HbA1c c. TG’s & cholesterol 1. Penile duplex sonography 2. Cavernosometry

Legend:
Endocrinologic Erectile Dysfunction
Hypogonadism, hyperprolactinemia, hyperthyroidism, alcoholism, iatrogenic
.J, circulating free testosterone
•
1. 4, 7 AM free testosterone* 2. l• Thyroid Stimulating Hormone 3. l• Prolactin 4. l• Follicle Stimulating Hormone 5. l• Luteinizing Hormone
4, release of NO and cGMP levels within corpora cavernosa and smooth muscle relaxation
Pathophysiology Mechanism
Neurogenic Erectile Dysfunction
Neurologic disease, trauma, iatrogenic, diabetes mellitus
Central (cerebral or spinal cord); peripheral (afferent/sensory neuropathy) or efferent (autonomic neuropathy)
4, parasympathetic nerve firing
4, NO release
Psychogenic Erectile Dysfunction
•
Sudden onset, sporadic (circumstantial), younger, nocturnal/AM erection present
•
Anxiety, depression, strained relationship, lack of sexual arousal, psychological disorder
Possible mechanisms include an imbalance of central neurotransmitters, over inhibition of spinal erection center by the brain, and sympathetic overactivity
1. Abnormal Nocturnal penile 1. Normal Nocturnal penile tumescence and rigidity* tumescence and rigidity*
Erectile Dysfunction -• (persistent or recurrent inability to achieve an erection sufficient to achieve desired sexual performance)
Sign/Symptoni/Lab Finding
Complications
Authors: Braden Milian Reviewers: Alex Tang Usama Malik Jay C. Lee* * MD at time of publication