Abstract
Over the past 20 years, many contributions have been made to our understanding of the mechanisms of erection as a result of penile vascular testing. The greatest medical advances in the management of male sexual dysfunction since the identification of androgens have been two discoveries: 1) that nitric oxide is the primary neuromodulator of penile smooth muscle relaxation, and 2) that oral phosphodiesterase type 5 inhibitors enhance erection quality through the nitric oxide mechanism. As a consequence of oral pharmacotherapies, the role of invasive diagnostics has diminished. Most guidelines recommend only history, physical examination, and limited laboratory testing before instituting oral therapies for erectile dysfunction (ED). We still have unanswered questions about ED. Can lifestyle changes alone improve erectile function? Is ED a marker for the development of atherosclerotic heart disease? What are the specific effects of known cardiovascular morbidities on penile vascular integrity? These questions will frame the role of future penile vascular diagnostics.
Published Version
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