Neurogenic Causes of erectile dysfunction

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.

Vasculogenic Causes of ED
Neurogenic Causes of ED
Endocrinological Causes of ED
Priapism and Postpriapism ED
Psychogenic Causes of ED

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.

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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