[The physiology of erection].
The majority of contemporary knowledge on the physiology of erection was assembled during the past thirty years. Today we consider erection as a multifactorial process. Mechanically it can be compared to an electromechanically controlled hydraulic system. Its function is conditioned by a number of mutually coordinated processes. As to nervous processes they include autonomous (parasympathetic and sympathetic) innervation, as well as somatic innervation (sensory and motor pathways). The control function is exerted by spinal as well as cerebral centres. As to mediators, in particular acetylcholine, nitrous oxide (NO) released from the endothelium are involved, noradrenaline, VIP (vasoactive intestinal polypeptide), CGRP (calcitonin gene-related peptide) and prostaglandins. The most important roles in the phase of erection are played by nitrous oxide and VIP. Erection can be either reflex erection, psychogenic or nocturnal or morning. It usually takes place in six stages (at rest, latent, the tumescence stage, complete erection, rigid erection and subsequently the stage of detumescence). Except for neurohumoral mechanisms an essential prerequisite for the development of erection are the arterial supply of the genital and the so-called venoocclusive mechanism. Erection takes the following course (simplified): erotogenic stimuli lead to the stimulation of the parasympathetic nerve-->vasodilating substances are released-->the s inusoids are filled with blood (tumescence stage)-->the venoocclusive mechanism starts to work: thus complete erection occurs. Then the contractions of the musculature of the perineum compress the proximal portions of the corpora cavernosa: this leads to rigid erection. Detumescence which occurs as a rule after ejaculation) is due to released noradrenaline (active stage) and the reduced tonus of the smooth muscles of the blood vessels (released endothelin and neuropeptide Y). Knowledge of the physiological mechanisms of erection made clinical diagnosis of their disorders and successful treatment of some forms of impotence possible.
Hora
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M
Urologická klinika LF UK a FN, Plzen.
Vozeh
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F
D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology*