Pathophysiology, evaluation and treatment of erectile dysfunction: review article

Abstract

Erectile dysfunction (ED) is the repeated inability to get and maintain an erection to enable satisfactory sexual activity and it’s the most common sexual dysfunction in aging men. It is estimated that 50% of men older than 40 years old exhibit this dysfunction. As the prevalence is significant, it is necessary to carry out a literature review of epidemiology, pathophysiology and treatment on the ED in order to better understand the disease. The erection is dependent on various factors such as smooth muscle relaxation of corpus cavernosum, increasing blood flow and restriction of venous outflow. These mechanisms may be impaired in several diseases, and, in some cases, ED can be considered as an early marker of more serious problems. This sexual dysfunction has several etiologies: vascular, endocrinological, neurological, psychological/psychiatric, drug-related or related to surgical interventions. Even the treatment of some underlying diseases may be the cause or the worsening of ED, as some antihypertensives and antidepressants. The main explanation for erectile dysfunction is the reduction of the availability of nitric oxide, an important vasodilator. However, mechanical obstruction of blood vessels and neurological stimuli transmission problems are also part of its pathophysiology. ED is first evaluated by the clinical method, but there are multidimensional evaluation instruments as the International Index of Erectile Function, considered the gold standard. The treatment for this disease should be established in its etiology. There are several lines of treatment, but phosphodiesterase-5 inhibitors and psychotherapy (for psychogenic or mixed ED) are the first choice, with or without testosterone replacement. As a second-line treatment there is intracavernous injection of vasoactive substances. If these therapies do not produce satisfactory results, the penile prosthesis may be indicated.