Erectile dysfunction is the persistent or recurrent inability to attain or maintain a penile erection sufficient for satisfactory sexual activity. Penile erection is a neurovascular event coordinated by neural signaling, smooth muscle relaxation, and arterial inflow: sexual stimulation triggers the release of nitric…
Erectile dysfunction is the persistent or recurrent inability to attain or maintain a penile erection sufficient for satisfactory sexual activity. Penile erection is a neurovascular event coordinated by neural signaling, smooth muscle relaxation, and arterial inflow: sexual stimulation triggers the release of nitric oxide, which elevates cyclic GMP, relaxing the smooth muscle of the corpora cavernosa so that blood fills the sinusoidal spaces while venous outflow is restricted, producing rigidity. Disruption at any point in this pathway can cause dysfunction. Etiologies are commonly classified as organic, psychogenic, or mixed. Organic causes include vascular disease and impaired endothelial function, diabetes-related neuropathy and microvascular damage, neurological disorders, hormonal abnormalities such as hypogonadism, the effects of certain medications, and endocrine conditions; psychological factors such as anxiety, depression, and relationship stress contribute alone or alongside organic disease. Because vascular erectile dysfunction may signal systemic endothelial or cardiovascular disease, it can serve as an early clinical marker. Evaluation combines history, physical examination, and selected laboratory and vascular assessment. Management ranges from lifestyle modification and treatment of underlying conditions to pharmacological therapy, notably phosphodiesterase type 5 inhibitors that potentiate the nitric oxide pathway, as well as injectable agents, devices, and surgical options. The condition also intersects with concerns about unregulated supplements marketed for sexual enhancement, which may contain undisclosed pharmaceutical adulterants.
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