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Review
. 2004 Apr 27;170(9):1429-37.
doi: 10.1503/cmaj.1020049.

Erectile dysfunction: management update

Luke Fazio  1 , Gerald Brock
Affiliations
Review

Erectile dysfunction: management update

Luke Fazio et al. CMAJ. .

Abstract

Dramatic advances in the management of erectile dysfunction have occurred over the past decade. Oral therapy with vasoactive agents has emerged as first-line treatment and has transformed both the manner in which the public views erectile dysfunction and the way health care providers deliver care. Whereas an extensive investigation was previously common in the management of erectile dysfunction, recent treatment guidelines promote a more minimalist, goal-oriented approach. In this article, we review the physiology of erection, and the pathophysiology, diagnosis and clinical management of erectile dysfunction. We also present the existing evidence for the efficacy of 3 phosphodiesterase inhibitors, the most widely used class of agents for erectile dysfunction.

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Figures

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Fig. 1: Anatomy and mechanism of penile erection. The erection pathway can be triggered by direct genital stimulation and by auditory and visual stimulation, which act in concert to increase penile blood flow. The penis has a highly specialized anatomical structure that allows a massive increase in blood flow to be trapped within the inelastic layers surrounding the penis (the tunica albuginea), which causes rigidity and expansion of the cavernosal smooth muscle. Photo: Christine Kenney
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Fig. 2: Cellular perspective of the erection pathway. The signal (nitric oxide) is released from nerve endings or from endothelial cells and activates a cascade reaction, which ultimately leads to an increased cellular concentration of cGMP (cyclic guanosine monophosphate). This second messenger molecule induces a series of events that lead to smooth-muscle relaxation through a reduction in the intracellular calcium ion concentration. The enzyme PDE-5 (phosphodiesterase type 5) reverses this effect by metabolizing the cGMP to GMP rapidly. The clinically important inhibitors of this enzyme (sildenafil, vardenafil and tadalafil) all act to promote smooth-muscle relaxation by their ability to allow cGMP to accumulate when nitric oxide is released, as is the case when sexual stimulation is present. Photo: Christine Kenney
See this image and copyright information in PMC

Comment in

  • Does testosterone affect effect?
    Danby B. Danby B. CMAJ. 2004 Sep 14;171(6):553; author reply 553. doi: 10.1503/cmaj.1040804. CMAJ. 2004. PMID: 15367447 Free PMC article. No abstract available.

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