Anatomy, physiology, and pathophysiology of erectile dysfunction.
BACKGROUND
Significant scientific advances during the past 3 decades have deepened our understanding of the physiology and pathophysiology of penile erection. A critical evaluation of the current state of knowledge is essential to provide perspective for future research and development of new therapies.


OBJECTIVE
To develop an evidence-based, state-of-the-art consensus report on the anatomy, physiology, and pathophysiology of erectile dysfunction (ED).


METHODS
Consensus process over a period of 16 months, representing the opinions of 12 experts from seven countries.


METHODS
Expert opinion was based on the grading of scientific and evidence-based medical literature, internal committee discussion, public presentation, and debate.


RESULTS
ED occurs from multifaceted, complex mechanisms that can involve disruptions in neural, vascular, and hormonal signaling. Research on central neural regulation of penile erection is progressing rapidly with the identification of key neurotransmitters and the association of neural structures with both spinal and supraspinal pathways that regulate sexual function. In parallel to advances in cardiovascular physiology, the most extensive efforts in the physiology of penile erection have focused on elucidating mechanisms that regulate the functions of the endothelium and vascular smooth muscle of the corpus cavernosum. Major health concerns such as atherosclerosis, hyperlipidemia, hypertension, diabetes, and metabolic syndrome (MetS) have become well integrated into the investigation of ED.


CONCLUSIONS
Despite the efficacy of current therapies, they remain insufficient to address growing patient populations, such as those with diabetes and MetS. In addition, increasing awareness of the adverse side effects of commonly prescribed medications on sexual function provides a rationale for developing new treatment strategies that minimize the likelihood of causing sexual dysfunction. Many basic questions with regard to erectile function remain unanswered and further laboratory and clinical studies are necessary.
Gratzke
Christian
C
Department of Urology, Ludwig-Maximilians-Universität, München, Germany.
Angulo
Javier
J
Chitaley
Kanchan
K
Dai
Yu-Tian
YT
Kim
Noel N
NN
Paick
Jaw-Seung
JS
Simonsen
Ulf
U
Uckert
Stefan
S
Wespes
Eric
E
Andersson
Karl E
KE
Lue
Tom F
TF
Stief
Christian G
CG
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D048909:Diabetes Complications / Q000150:complications; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D009130:Muscle, Smooth / Q000503:physiopathology; D016202:N-Methylaspartate / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D010413:Penis / Q000033:anatomy & histology* / Q000502:physiology / Q000503:physiopathology*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use
D010726:Phosphodiesterase Inhibitors; D010121:Oxytocin; D016202:N-Methylaspartate; D000324:Adrenocorticotropic Hormone