title: Does anatomy of the pubic arch interfere with the maintaining of erection?
abstract: OBJECTIVE
  There are men who suffer from unsustainable erections without any identified cause of erectile dysfunction, raising the question if anatomical alterations could be involved. Since early anatomical studies, it has been proposed that to achieve full penile rigidity, the blood must be blocked inside the penis by compression of the deep dorsal vein (DDV), the main venous collector under pubic symphysis. Using a recently developed caverno computed tomography (CT) scan technique, allowing the evaluation of the venous drainage of the corpora cavernosa (CC) during erection, we have studied some anatomical conditions of this important part of the erectile phenomenon.
  
  
  METHODS
  Puboischial rami angles were measured in axial CT images and calculated strictly on the upper insertion point of the CC, using axial submillimeter slices in 37 patients divided into 3 groups depending on the results of the caverno CT scan: (i) no leak; (ii) superficial veins leaking; and (iii) drainage through the DDV and/or preprostatic plexus. In addition same angles were measured in two randomly unselected populations of men (N = 30), and women (N = 23) who underwent pelvic CT scan for various reasons, unrelated to their sexual or genital condition.
  
  
  METHODS
  The angles made by both puboischial rami were measured in patients with and without veno-occlusive dysfunction and in unselected samples of men and women.
  
  
  RESULTS
  There is a significantly wider angle made by both puboischial rami in men without complete erection and without evidence of anomalous venous drainage (group 3) (72.2° ± 4.7° standard deviation [SD]), compared with both men with normal erection (group 1) (57.5 ± 5° SD) P < 0.00001, and men with incomplete erection and evidence of anomalous drainage (group 2) (57.7 ± 6° SD) P < 0.00001.
  
  
  CONCLUSIONS
  If confirmed in larger samples, these results raise new questions on the mechanism and the role of these significant anatomical variations, yet unknown, in maintaining or not full rigid erections.
authors.affiliation: Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Paul
authors.forename: Ronald
authors.initials: R
authors.lastname: Virag
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000098:blood supply / Q000000981:diagnostic imaging; D011630:Pubic Bone / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media