1. ErectileDysfunction
By
Waleed Dawood

2. Erectile Dysfunction
Meaning :
The inability to achieve and maintain a penile
erection satisfactory for sexual intercourse
(Does not include ejaculation disorders)

3. Anatomy of the penis
• Tunica Albuginea
• Corpora Cavernosa
-- Sinusoid
• Corpus Spongiosum
-- Sinusoid
• Glans Penis
• Artrial supply
• Venous drainage
• Nerve

4. Arterial Supply
• Internal iliac artery
• internal pudendal artery
[main]
– Dorsal artery
– Bulbourethral artery
– Cavenous artery
• External iliac, Obturator,
vesical and femoral
artery. [accessory]

5. Venous drainage
• Emissary veins,
transformed from
peripheral sinusoids
• Deep dorsal vein [main]
• Bulbourethral vein,
Cavernous vein
[ accessory]

6. Mechanism of erection :
Dilatation arterioles&arteries
expanding of sinusoids
compression of subtunical
venular plexuses
Emissary veins enclosed
increasing of intracavernous
pressure to raise the penis

7. Mechanism of Detumescence
Transient intracorporeal pressure increase
[smooth muscle contraction]
Pressure decrease slowly
[slow reopening of the venous channels]
Pressure decrease fast
[venous outflow capacity is fully restored]

8. Neuroanatomy of penile erection
• Peripheral pathways
– autonomic [ C. Cavenosa & C. Spongiosum]
– somatic [ Glans Penis & C. Spongiosum]
Sympa, - NE release
Parasym, + NO & Ach release
Somatic, +Ach release

9. Neuroanatomy of penile erection
• Supraspinal pathways
[ hypothalamus, limbic system and cerebral cortex]
dopaminergic & adrenergic recepters promotes sexual
drive
serotonin recepters inhibits sexual
drive

10. Classification of Erectile
Dysfunction
• Psycogenic
• Neurogenic
• Endocrinologic
• Arteriogenic
• Cavernosal (Venogenic)
• Drug-induced
• Erectile dysfunction associated with
aging, systemic disease & others

11. Cause of Erectile Dysfunction
Alcohol Abuse Anxiety
or Depression
Coronary Artery Disease Diabetes
Hormonal Abnormalities
Hypertension
Peripheral Vascular Disease
Renal or Hepatic Failure
Anemia Smoking
Surgery(Pelvic or Perineal)
Trauma to pelvic or spine
Medication : AntiHT, Antidepressant,

13. Treatments
of
Erectile Dysfunction

14. Treatments of Erectile Dysfunction
Drug Therapy :
Orally Administration
Intracarvernous Injection
MUSE or Intraurethral
Suppository
Vacuum Devices
Horrmone Replacement Therapy
Surgery
Others

15. • Drug Therapy : Orally Administration
Yohimbine
Phentolamine
Apomorphine
Sildenafil
Treatments of Erectile Dysfunction

16. Yohimbine
alpha 2 -antagonist
Side effect : anxiety, tachycardia
Treatments of Erectile Dysfunction
Drug Therapy : Orally Administration

17. Apomorphine (Sublingual)
Stimulate brain dopaminergic mechanism
Side effect : nausea, vomit, yawn
Treatments of Erectile Dysfunction
Drug Therapy : Orally Administration

18. Sildenafil
Phosphodiesterase Inhibitor
Side effect : headache, flushing, dyspepsia
visual disturbance
Contraindication : co-administration with nitrate
MI, CHF
Treatments of Erectile Dysfunction
Drug Therapy : Orally Administration

19. Intracavernous Injection
vasoactive agents into corpora cavernosa
erection
Vasoactive Agent
Papaverine
Phentolamine
Alprostadil
Treatments of Erectile Dysfunction

20. Intracavernous Injection
Side effect : priapism, small
nodule, subcutaneous
hemorrhage, pain,
trauma, scar
Treatments of Erectile Dysfunction

21. Intraurethral suppositories
“MUSE” (Medicated urethral system
for erection)
Treatments of Erectile Dysfunction

23. Vacuum Devices
Treatments of Erectile Dysfunction

24. Hormone Replacement
Therapy :
Testosterone
Treatments of Erectile Dysfunction

25. Surgery
Treatments of Erectile Dysfunction

26. The End