The dependence of normal erectile and ejaculatory function on intact neural pathways to and from the brain has already been mentioned. Not surprisingly a considerable number of neurological disorders may result in erectile dysfunction (Table 3).
Those involving the central nervous system include cerebrovascular accidents, Parkinson’s disease and multiple sclerosis.
Damage or degeneration of peripheral nerves supplying the corpora also results in erectile dysfunction. Examples include diabetic neuropathy, cauda equina lesions due to a prolapsed intervertebral disk, and iatrogenic neural injury during abdominoperineal resection of the rectum. The unusual, but interesting, disorder known as multiple system atrophy is characterized by degeneration of both the sympathetic and parasympathetic central and peripheral autonomic neurons, as well as of Onuf’s nucleus in the sacral spinal cord (
Figure 31). The result is progressive and disabling ortho static hypotension, urinary incontinence and erectile dysfunction, together with ejaculatory failure.
- Arterial Blood Supply
- Venous Drainage
- Lymphatic Drainage
- Central Nervous System Connections
- Causes of erectile dysfunction
- Vasculogenic Causes
- Neurogenic Causes
- Endocrinological Causes
- Priapism and Postpriapism ED
- Psychogenic Causes
- Risk factors for erectile dysfunction
- Diagnosis of erectile dysfunction Treatment of erectile dysfunction Erectile Dysfunction - Conclusions
Table 3 Neurogenic pathophysiology of organic erectile dysfunction
Diabetes, alcoholism/vitamin deficiencies contribute to somatic/autonomic neuropathy
Demyelinating diseases (e.g. multiple sclerosis) decrease penile sensation
Aging elevates sensory thresholds to vibratory/electrical stimulation
Pelvic/retroperitoneal surgery (e.g. radical prostatectomy) may damage the autonomic nervous system controlling the physiology of penile erection/ejaculation