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Male Sexual Dysfunction Epidemiology

Male Sexual Dysfunction May 05, 2006 In the Massachusetts Male Aging Study, a community-based survey
of men between 40 and 70 years of age, 52% of respondents reported some degree of ED: 17% mild, 25%
moderate, and 10% complete. Although the prevalence of mild ED remained constant (17%) between the
ages of 40 and 70, there was a doubling in the number of men reporting moderate ED (from 17% to 34%)
and a tripling in the number of men reporting complete ED (from 5% to 15%). Among the major predictors
of ED are diabetes mellitus, heart disease, hypertension, and decreased high-density lipoprotein level. There
is a higher prevalence of ED in men who have undergone radiation or surgery for prostate cancer. The
psychological correlates of ED include depression and anger (Feldman et al, 1994). In the National Health
and Social Life Survey in men aged 18-59, other male sexual dysfunctions were also found to be highly
prevalent: premature ejaculation (28.5%), lack of sexual interest (15.8%), anxiety about sexual

performance (17%), and lack of pleasure in sex (8.1%) (Laumann et al, 1994).

Classification & Pathogenesis

A new classification of ED has been recommended by the International Society of Impotence Research
(Lizza and Rosen, 1999). In the 1950s, 90% of cases of ED were believed to be psychogenic. Most authors
now believe that mixed organic and psychogenic ED is the most
common.

Psychological Disorders

Many psychologic conditions (performance anxiety, strained relationship, lack of sexual arousal, depression,
and schizophrenia) can either cause or aggravate ED. The pathogenesis of psychogenic ED is still
speculative. The most cited include imbalance of central neurotransmitters, over-inhibition of spinal erection
center by the brain, inadequate NO release, and sympathetic overactivity.

Male Sexual Dysfunction

o Introduction
o Physiology of Penile Erection
o Male Sexual Dysfunction
o Epidemiology
o Diagnosis & Treatment
o Nonsurgical Treatment
o Penile Vascular Surgery
o Penile Prosthesis
o Involving Emission, Ejaculation, & Orgasm

Neurogenic Disorders

ED can be caused by disease or dysfunction of the brain, spinal cord, or cavernous and pudendal nerves. In
men with spinal cord injury, the degree of erectile function depends on the nature, location, and the extent
of the lesion. Peripheral neuropathy as seen in diabetes mellitus, chronic alcohol abuse, or vitamin
deficiency may affect the nerve endings and result in a deficiency of neurotransmitters. Direct injury to the
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cavernous or pudendal nerves from trauma or radical prostatic or rectal surgery also can cause disruption of
the neural pathway and result in ED.

Hormonal Disorders

Hypogonadism due to hypothalamic or pituitary tumors, estrogen or antiandrogen therapy, or orchiectomy

can suppress sexual interest and nocturnal erections. However, these patients may achieve varying degree
of erections during visual sexual stimulation (Bancroft and Wu, 1983), and thus, the erectile ability is preserved.
Similarly, ED resulting from hyperprolactinemia is probably caused by suppressed sexual interest.
Hyperthyroidism, hypothyroidism, Cushing syndrome, and Addison disease are all reported to cause
decreased libido and ED. Whether the hormonal disturbance or other factors are responsible for the ED
needs further investigation.

Arterial Disorders

Although arteriogenic ED may be due to trauma or may be congenital, most often it is part of a generalized
systemic arterial disease. The distribution and severity of the disease, however, differ from person to
person. Some patients with severe arterial disease may still be potent as long as the arterial flow exceeds
the venous flow; conversely, some patients with minimal arterial disease may be partially or completely
impotent because of relatively large venous outflow, cavernous smooth-muscle dysfunction, or inadequate
neurotransmitter release.

Arterial disease can be classified as extra- or intrapenile arterial insufficiency. Extrapenile arterial disease is
amenable to surgical repair and comprises diseases of the internal pudendal artery, internal and common
iliac arteries and aorta, the pelvic steal syndrome, and pelvic trauma. Intrapenile arterial disease such as
that resulting from aging, arteriosclerosis, or diabetes mellitus does not respond well to currently available
surgical techniques.

Cavernosal Disorders

Cavernous (venous) impotence can be divided into 5 types according to cause: In type 1, large veins exit
the corpus cavernosum (this type is probably congenital); in type 2, venous channels are enlarged as a
result of distortion of the tunica albuginea (as in Peyronie disease or the weakening associated with aging);
in type 3, the cavernous smooth muscle is unable to relax because of fibrosis, degeneration, or dysfunction
of gap junctions; in type 4, there is inadequate neurotransmitter release (in neurologic or psychological
impotence or endothelial dysfunction); and in type 5, there is abnormal communication between the corpus
cavernosum and the spongiosum or glans (congenital, traumatic, or consequent to shunt procedure for
priapism) (Lue, 2000). Electron microscope studies of cavernous erectile tissue obtained during implantation of
penile prostheses reveal a high incidence of smooth-muscle atrophy, fibrous replacement, and endothelial
disruption in patients with diabetes mellitus and Atherosclerosis (Mersdorf et al, 1991). Studies of penile tissue
obtained by needle biopsy have also revealed changes in the smooth muscle-collagen ratio, decreased
endothelium, and diminished elastic fibers in impotent patients and impaired smooth-muscle relaxation in
diabetic patients (Saenz de Tejada et al, 1989; Sattar et al, 1995).