Male sexual dysfunction

Carlos Singer, William J. Weiner

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND- Sexual dysfunction symptomatology is a common manifestation in a variety of neurological and non-neurological disorders. Neurologists are frequently poorly prepared to systematically analyze and evaluate these symptoms. The present review discusses male sexual dysfunction in the areas of erectile and ejaculatory performance and provides the clinician with basic concepts of neuroanatomy, neurophysiology, clinical history, diagnosis, and treatment. REVIEW SUMMARY- The parasympathetic and sympathetic nervous systems play complementary but incompletely understood roles in erectile function. A noncholinergic-nonadrenergic pathway mediated by nitric oxide and facilitated by acetylcholine may represent the final step in the generation of erections by promoting blood flow into the dilated cavernosal lacunar spaces. Erection is then maintained by trapping blood via veno-occlusive mechanisms. Seminal emission and ejaculation are primarily dependent on adequate sympathetic function. The somatic nervous system is responsible for the initial afferent tactile information of the sexual response and for the perineal muscular contraction at the time of ejaculation. Clinical history allows for an initial impression regarding organicity vs. psychogenicity of the erectile difficulties and distinguishes three principal disorders of ejaculation (premature ejaculation, dry ejaculation, and ejaculatory incompetence). CONCLUSIONS- Erectile dysfunction can be organic (neurogenic, endocrinogenic, iatrogenic, vasculogenic) or psychogenic. Most patients will require baseline hormonal determinations. Nocturnal penile tumescence studies are crucial to determine presence of psychogenicity. Neurophysiological intracavernosal pharmacotherapy and noninvasive vacuum erection devices should precede consideration of prostheses. There are no laboratory studies for ejaculatory disorders. Premature ejaculation and ejaculatory incompetence are treated by the sex therapist. Dry ejaculation may require withdrawal of potential iatrogenic causes, treatment of underlying erectile dysfunction (if present), or use of special invasive techniques for those seeking treatment of infertility.

Original languageEnglish
Pages (from-to)119-129
Number of pages11
JournalNeurologist
Volume2
Issue number2
StatePublished - Dec 1 1996

Fingerprint

Ejaculation
Premature Ejaculation
Erectile Dysfunction
Parasympathetic Nervous System
Penile Erection
Neuroanatomy
Neurophysiology
Sympathetic Nervous System
Touch
Vacuum
Muscle Contraction
Infertility
Nervous System
Acetylcholine
Prostheses and Implants
Nitric Oxide
Therapeutics
Drug Therapy
Equipment and Supplies

Keywords

  • Diabetes
  • Dry ejaculation
  • Ejaculation
  • Ejaculatory incompetence
  • Erectile dysfunction
  • Erection
  • Impotence
  • Multiple sclerosis
  • Multiple system atrophy
  • Parkinson's disease
  • Premature ejaculation
  • Seminal emission
  • Sex disorders
  • Spine trauma

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Singer, C., & Weiner, W. J. (1996). Male sexual dysfunction. Neurologist, 2(2), 119-129.

Male sexual dysfunction. / Singer, Carlos; Weiner, William J.

In: Neurologist, Vol. 2, No. 2, 01.12.1996, p. 119-129.

Research output: Contribution to journalArticle

Singer, C & Weiner, WJ 1996, 'Male sexual dysfunction', Neurologist, vol. 2, no. 2, pp. 119-129.
Singer C, Weiner WJ. Male sexual dysfunction. Neurologist. 1996 Dec 1;2(2):119-129.
Singer, Carlos ; Weiner, William J. / Male sexual dysfunction. In: Neurologist. 1996 ; Vol. 2, No. 2. pp. 119-129.
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abstract = "BACKGROUND- Sexual dysfunction symptomatology is a common manifestation in a variety of neurological and non-neurological disorders. Neurologists are frequently poorly prepared to systematically analyze and evaluate these symptoms. The present review discusses male sexual dysfunction in the areas of erectile and ejaculatory performance and provides the clinician with basic concepts of neuroanatomy, neurophysiology, clinical history, diagnosis, and treatment. REVIEW SUMMARY- The parasympathetic and sympathetic nervous systems play complementary but incompletely understood roles in erectile function. A noncholinergic-nonadrenergic pathway mediated by nitric oxide and facilitated by acetylcholine may represent the final step in the generation of erections by promoting blood flow into the dilated cavernosal lacunar spaces. Erection is then maintained by trapping blood via veno-occlusive mechanisms. Seminal emission and ejaculation are primarily dependent on adequate sympathetic function. The somatic nervous system is responsible for the initial afferent tactile information of the sexual response and for the perineal muscular contraction at the time of ejaculation. Clinical history allows for an initial impression regarding organicity vs. psychogenicity of the erectile difficulties and distinguishes three principal disorders of ejaculation (premature ejaculation, dry ejaculation, and ejaculatory incompetence). CONCLUSIONS- Erectile dysfunction can be organic (neurogenic, endocrinogenic, iatrogenic, vasculogenic) or psychogenic. Most patients will require baseline hormonal determinations. Nocturnal penile tumescence studies are crucial to determine presence of psychogenicity. Neurophysiological intracavernosal pharmacotherapy and noninvasive vacuum erection devices should precede consideration of prostheses. There are no laboratory studies for ejaculatory disorders. Premature ejaculation and ejaculatory incompetence are treated by the sex therapist. Dry ejaculation may require withdrawal of potential iatrogenic causes, treatment of underlying erectile dysfunction (if present), or use of special invasive techniques for those seeking treatment of infertility.",
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KW - Spine trauma

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