Male erectile dysfunction

Sexual dysfunction is a common, almost expected, consequence of autonomic dysfunction. Neurologic disease can produce discrete lesions in central or peripheral nerves which cause erectile dysfunction by altering nerve function or can alter nitric oxide production at the penile corporal artery neuromuscular junction and vascular endothelium. Generation of nitric oxide by the penile cavernous nonadrenergic noncholinergic (NANC) nerves and by the vascular endothelium appears to be a critical trigger for the erectile mechanism. Loss of NANC nerve function can markedly impact the patient's ability to achieve an erection. Conditions including Parkinson’s disease, multi-system atrophy (MSA), multiple sclerosis, and most other neurologic disorders are associated with a high rate of erectile dysfunction. Treatment begins with oral PDE- 5 inhibitors in all cases except MSA. Patients with MSA often experience profound systolic and diastolic hypotension upon PDE-5 administration.