Impotence. Pathophysiology. 

Vincent Chang

Impotence = Manhood Missing!

Difficulty in initiating or maintaining penile erection adequate for sexual relations.

Impotence = Erectile DysfunctionDifficulty in initiating or maintaining penile erection adequate for sexual relations.

•Psychological•Neurological•Hormonal•Vascularcombinations.

Comorbidities and Risk factors

Major risks to men's health such as diabetes, and cardiovascular risk :hypertension, hyperlipidemia, and angina.- Well established early marker

Of the 2004 cohort, 20.7% had been diagnosed with diabetes, 44.3% with hypertension, 42.5% with hyperlipidemia, and 25.7% with angina. 

Large population-based studies:1. Men's Attitudes to Life Events and Sexuality (MALES) (2001 – 2004)Europe, North and South America

2.The Massachusetts Male Aging Study (MMAS) (1987-2004) Boston Area, US

3. ENIGMA study in 2004 Netherlands, Europe

One of the largest current studies of ED, the MassachusettsMale Aging Study, found that ED may be present in up tohalf of the male population between 40 and 70 years old[1].

This condition has been estimated to affect 150 millionindividuals worldwide [2] and data from the suggested that the condition is prevalent inapproximately 17% of all Europeanmen

ED had a significant negative influence on the happiness of life.

Comorbidities and Risk factors

Major risks to men's health such as diabetes, and cardiovascular risk :hypertension, hyperlipidemia, and angina.

Of the 2004 cohort, 20.7% had been diagnosed with diabetes, 44.3% with hypertension, 42.5% with hyperlipidemia, and 25.7% with angina. 

Large population-based studies:1. Men's Attitudes to Life Events and Sexuality (MALES) (2001 – 2004)Europe, North and South America

2.The Massachusetts Male Aging Study (MMAS) (1987-2004) Boston Area, US

3. ENIGMA study in 2004 Netherlands, Europe

One of the largest current studies of ED, the MassachusettsMale Aging Study, found that ED may be present in up tohalf of the male population between 40 and 70 years old[1].

This condition has been estimated to affect 150 millionindividuals worldwide [2] and data from the suggested that the condition is prevalent inapproximately 17% of all Europeanmen

ED had a significant negative influence on the happiness of life.This condition has been estimated to affect 150 million individuals worldwide.

Sexual stimulation and transmission of nerve impulses from the brain to the penile tissueDilation of arteries in the cavernous body and inflow of bloodBlock of blood outflow in the veins of the penis

The technology of erection is purely based on pressure.

1. Psychological and Neurological Pathologies:

Injury to the spinal cord may interrupt neural pathways to the sacral region, preventing erection

•Anxiety – Teenagers and young men•Stress – Middle Age men•Depression•Lack of sexual arousability

Interfere with brain’s perception of arousal:oSchizophrenia oAlzheimer’soStrokeoParkinson’sobrain trauma

2. Hormonal factor

Natural aging process - decline in testosterone production level

•Adrenocorticotropic hormone ACTH -  corticosteroids•Oxytocin•Prolactin•Androgens•TestosteroneHypogonadism - threshold level oftestosterone is necessary for erection to occur

3. Vascular and NO pathologies contributed to ED

•Peripheral arterial disease and endothelial/smooth muscle dysfunctionseen in diabetes mellitus, atherosclerosis, coronary

•Nitric Oxide the main vasoactive neurotransmitter involved in the erectile response•Arousal stimulates NO released from nonadrenergic,

noncholinergic (NANC) neurons• Shear forces also stimulate NO production by eNOS in the endothelium

NO Mechanism & Erection

Erecting Erected

PDE 5Flacid

•Arousal stimulates NO released from (NANC) neurons

phosphodiesterase

Therapeutic approaches for ED•Current standard of care for ED consists oflifestyle changes such as management of diet, weight loss

•Appropriate treatment for diabetes, hypertension

•The current gold standard treatment is the use of PDE 5 inhibitors such as sildenafil citrate.

•ED pump therapy •Hydraulic pump

Therapeutic approach for ED•Current standard of care for ED consists oflifestyle changes such as management of diet, weight loss

•Appropriate treatment for diabetes, hypertension

•The current gold standard treatment is the use of PDE 5 inhibitors such as sildenafil citrate.

•ED pump therapy •Hydraulic pump

Therapeutic approach for ED

current standard of care for ED consists of lifestylechanges such as management of diet, diabetes, hypertension,and weight loss, along with pharmacotherapies. The currentgold standard treatment is the use of phosphodiesterase5 inhibitors such as sildenafil citrate.

Therapeutic approach for ED

current standard of care for ED consists of lifestylechanges such as management of diet, diabetes, hypertension,and weight loss, along with pharmacotherapies. The currentgold standard treatment is the use of phosphodiesterase5 inhibitors such as sildenafil citrate.

Therapeutic approach for ED

current standard of care for ED consists of lifestylechanges such as management of diet, diabetes, hypertension,and weight loss, along with pharmacotherapies. The currentgold standard treatment is the use of phosphodiesterase5 inhibitors such as sildenafil citrate.

Q?

Thank you! :)