Anatomy and physiology of Erection & pathophysiology of erectile dysfunction
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presentation given at ASI conference, Indore, MP, India
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Anatomy and physiology of Erection & pathophysiology of erectile dysfunction
- 7. Normal physiological Erection Psycho – Neuro- Vascular Event Psycho Dynamics Neuro-Dynamics Hemo-Dynamics
- 8. Cellular/Molecular - Dynamics At Receptor Level In side the cells in cytosole
- 17. Pudendal nerve S2,S3,S4 Sensation from glans- Dorsal Nerve of Penis Contraction of ischiocavernosus and bulbospongiosus Sympathetic (T11-L2)- cavernosal nerve Parasympathetic - cavernosal nerve S2, S3, S4
- 22. Cerebral cortex – thinking about sex ( cognitive and social behaviour) Limbic system - how we feel about sex, how we behave sexually Hypothalamus - stimulation triggers arousal > orgasm LEVEL REGION FUNCTION Forebrain Amygdala Control sexual motivation Pyriform cortex Inhibits sexual drive Hippocampus Involved in penile erection Hypothalamus MPOA Ability to recognize a sexual partner PVN Facilitates penile erection Brain stem Nucleus paragigantocellularis Inhibits penile erection Midbrain Periaqueductal gray Relay center for sexually relevant stimuli Touch , Vision, Smell, Taste, Hearing
- 24. Dilatation of arterioles & arteries Trapping of blood in sinusoids Compression of subtunical venular plexus Occlusion of emissary veins Phase of full Ercection Phase of rigid erection Physiology of Erection
- 27. Detumescense Phase I- increase in pressure Phase II- slow decrease in presssure Phase III- rapid fall in pressure
- 28. Etiology
- 30. Hypertension Hyperlipidemia Cigarette smoking Diabetes mellitus Blunt perineal trauma Pelvic trauma Pelvic irradiation
- 31. Failure of adequate venous occlusion has been proposed as one of the most common causes of vasculogenic impotence • Peyronie’s disease • Traumatic injury to the tunica albuginea (penile fracture) • Acquired venous shunts---the result of operative correction of priapism • Insufficient trabecular smooth muscle relaxation- anxious individual
- 32. Mixed causes Fibroelastic component Smooth muscle Endothelium Gap junction In vasculogenic and neurogenic ED, the damaged smooth muscle can be a key factor, aggravating the primary cause.
- 33. Neurogenic 10-19% Parkinson’s disease, stroke, encephalitis, or temporal lobe epilepsy Iatrogenic- Radical prostatectomy 43% to 100% Abdominal perineal resection- 15% to 100% Pelvic trauma
- 34. Take home message Considerable events can cause erectile dysfunction. No one cause may be involved independently. A cascade of issues (including psychological as well as organic) can lead the to the impotent state. A continued understanding of the organic causes of erectile dysfunction will allow the physician to discover therapies for correction as
Editor's Notes
- Atherosclerotic or traumatic arterial occlusive disease of the hypogastric-cavernous-helicine arterial tree can decrease the perfusion pressure and arterial flow to the sinusoidal spaces, thus increasing the time to maximal erection and decreasing the rigidity of the erect penis. In the majority of patients with arteriogenic ED, the impaired penile perfusion is a component of the generalized atherosclerotic process. On arteriography, bilateral diffuse disease of the internal pudendal, common penile, and cavernous arteries has been found in impotent patients with atherosclerosis. Focal stenosis of the common penile or cavernous artery is most often seen in young patients who have sustained blunt pelvic or perineal trauma.77 Long-distance cycling is also a risk factor for vasculogenic and neurogenic ED.80, 81
- Loss of compliance of the penile sinusoids associated with increased deposition of collagen and decreased elastic fibers may be seen in diabetes, hypercholesterolemia, vascular disease, penile injury, or old age.
- It has been estimated that 10 to 19% of ED is of neurogenic origin.46, 47 If one includes iatrogenic causes and mixed ED, the prevalence of neurogenic ED is probably much higher. While the presence of a neurologic disorder or neuropathy does not exclude other causes, confirming that ED is neurogenic in origin can be challenging. Because an erection is a neurovascular event, any disease or dysfunction affecting the brain, spinal cord, cavernous and pudendal nerves can induce dysfunction.