Chapter 34 Erectile dysfunction – diagnostic approach and treatment options

Abstract

Erectile dysfunction (ED) is the consistent inability to attain or maintain a penile erection sufficient for satisfactory sexual intercourse, responsible are psychogenic, vascular, endocrine, metabolic and neurogenic dysfunction. Erectile dysfunction occurs together with other neurological diseases, such as multiple sclerosis, Parkinson's disease, brain, and spinal tumors, brain and spinal cord injuries, degenerative disorders of the spine, paraplegia, neurosyphilis, Alzheimer's disease, polyneuropathies, diabetic neuropathy and alcoholic neuropathy, and disorders of the autonomic nervous system. Erection is induced by non-cholinergic, non-adrenergic neurotransmitters vasoactive intestinal polypeptide (VIP) and nitricoxide (NO). Physical examination of erectile disfunction comprises a urological examination for abnormalities, such as penile curvature, small testes, or prostate disease, vascular dysfunction, systemic or endocrine diseases, and examination of the peripheral pulses. The neurologic examination includes evaluation of genital and perianal sensation and the bulbocavernosus reflex. The laboratory screening includes a blood cell count, analysis of fasting blood glucose, HbAlc, lipid profile, creatinine, prostate-specific antigen, TSH, and electrolytes.