Erectile DysfunctionIt will not come as a surprise to many that erectile dysfunction or impotence – the failure to initiate, achieve or maintain an erection – is a common problem among men. Regaling tales of men having ‘one too many’ beers and suffering the flaccid effects of the infamous ‘brewer’s droop’ are certainly commonplace, yet those who experience erectile dysfunction on a more regular basis are more likely to keep quiet. Because of this, the exact prevalence of erectile dysfunction is not known. What is known is that its prevalence increases with age [1], and that the condition can have devastating effects on love-life, self-esteem and relationships. Erections occur as a result of neurotransmission and vascular smooth-muscle responses that culminate in increased blood flow and signaling between endothelial-lined cavernosal sinusoids and the smooth muscle cells within the corpora cavernosa. Nitric oxide, produced by parasympathetic non-adrenergic and non-cholinergic neurons and endothelial cells, initiates a molecular cascade that results in the relaxation of smooth muscle cells. This process occludes venous blood return through the compression of the subtunical venules, thereby causing an erection [2]. Inability to achieve or maintain an erection is generally the result of one or more factors in this pathway becoming compromised. These interferences may be precipitated by purely physiological factors such as poor blood flow to the genital area or decreased nitric oxide production (often because of alcohol), psychological factors, or both.
1. Heiman J (2002) Sexual dysfunction: overview of prevalence, etiological factors, and treatments - Statistical Data Included, Journal of Sex Research 39(1):73-8. 2. McVary KT (2007) Erectile Dysfunction, The New England Journal of Medicine 357(24): 2472-2481.
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