Electronic ISSN 2287-0237

VOLUME

ERECTILE DYSFUNCTION

FEBRUARY 2016 - VOL.11 | REVIEWS ARTICLE

Erectile dysfunction (ED) is an important issue in sexual relationships and can affect family and lead to other problems. Hence, ED treatments are widely acceptable with high efficacy rates and with low risks of adverse side effects at the present time. Physicians and healthcare workers should study and understand all mechanisms, history, family environment, underlying diseases for instance DM, hypertension and hypercholesterinemia. A better understanding of these underlying factors may help provide an appropriate consultation. The various treatments on offer include psycho- therapy and sex therapy. Medical therapy, mechanical devices, vascular surgery, combined therapy or others including topical PGE, gene therapy and testosterone are also available. Each case is different and the patient may select one or multiple kinds of treatment, suitable for them, whilst the physician may suggest or give guidelines to patients to help ensure the best clinical outcome.

Keywords:

penile erection, erection dysfunction (ED) neurotransmitters, phophodi- esterase type 5 (PDE5) inhibitor, intraurethral medications, intracavernosal injection therapy, vacuum devices, and penile prosthesis devices

MEDIA
Figure 1:
Prevalence of erectile dysfunction (ED) in Thai men.
Figure 2:
Peripheral nervous system responsible for controlling penile erection.
Figure 3:
Mechanisms of psychogenic erection via medial preoptic area (MPOA) and reflexogenic erection via pudendal nerve are shown in this figure.
Figure 4:
The pathways involved in causing a penile erection after stimulation. The nitrergic pathway uses nitric oxide that induces the production of cGMP and the vipergic pathway uses Ach and VIP that stimulate the production of cAMP. Both cGMP and cAMP cause a reduction in intracellular calcium level that causes relaxation of the smooth muscle. [GTP (guanosine triphosphate), cGMP (cyclic guanosine monophosphate), GMP (guanosine monophosphate), ATP (adenosine triphosphate), cAMP (cyclic adenosine monophosphate), AMP (adenosine monophosphate), PKG (protein kinase G), PKA (protein kinase A), Vasoactive intestinal peptide (VIP), VIP-R (VIP receptor), EP-R (prostaglandin receptor), eNOS (endothelial nitric oxide synthase), nNOS (neural nitric oxide synthase), NANC (nonadrenergic noncholinergic), PDE (phosphodiesterase), Ach (acetylcholine), E (epinephrine), NE (norepinephrine), Alpha ad – R (alpha adrenergic receptor), NO (nitric oxide)].
Characteristics listed in this table can be used to help distinguish psychogenic erectile dysfunction from organic erectile dysfunction.
Figure 5:
Mechanisms of sildenafil.
Table 2:
Adverse effects from sildenafil compared with placebo.
Table 3:
Inhibitory concentrations of sildenafil, tadalafil, and vardenafil.
Figure 6:
MUSE™ applicator stem is inserted into the urethra often after urination to provide moisture. The button is gently pressed to deposit the pellet inside the urethra. Massage the penis with both hands to dissipate the drug and help speed up absorption.
Figure 7:
A vacuum constriction device.
Figure 8:
Three-piece hydraulic penile implant- consisting of the cylinders, pump, and a reservoir bag.
Figure 9:
A surgical procedure installing a three-piece penile implant at Bangkok Hospital through a small incision at the penoscrotal junction.
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