Pathophysiology of Erectile Dysfunction: Difference between revisions

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 * See Tables 26-11 and 26-12
 * Self-reported and questionnaire data concerning ED as a medication side effect should be interpreted with caution
-* '''Antihypertensive Agents'''
-** '''Almost all antihypertensive drugs have ED listed as a potential side effect''', though recent well-designed controlled clinical trials have clarified their association with ED
+===== Antihypertensive Agents =====
-** '''Associated with ED'''
+* '''Almost all antihypertensive drugs have ED listed as a potential side effect''', though recent well-designed controlled clinical trials have clarified their association with ED
-**# '''α2-agonists (e.g. clonidine)'''
+* '''Associated with ED'''
-**# '''Diuretics'''
+*# '''α2-agonists (e.g. clonidine)'''
-**** Spironolactone is a nonselective mineralocorticoid receptor antagonist with moderate affinity for progesterone and androgen receptors. The latter property increases the likelihood of endocrine side effects, including loss of libido, gynecomastia, and impotence
+*# '''Diuretics'''
-** '''Not associated with ED'''
+*#* Spironolactone is a nonselective mineralocorticoid receptor antagonist with moderate affinity for progesterone and androgen receptors. The latter property increases the likelihood of endocrine side effects, including loss of libido, gynecomastia, and impotence
-**# '''ACE-inhibitors'''
+* '''Not associated with ED'''
-**# '''ARBs'''
+*# '''ACE-inhibitors'''
-**# '''α1-blockers'''
+*# '''ARBs'''
-**#* May cause retrograde ejaculation
+*# '''α1-blockers'''
-**# '''Calcium channel blockers'''
+*#* May cause retrograde ejaculation
-*** ARBs and α-blockers may exert a positive effect of erectile function§
+*# '''Calcium channel blockers'''
-** '''Variably associated with ED'''
+** ARBs and α-blockers may exert a positive effect of erectile function§
-*** '''β-blockers:'''
+* '''Variably associated with ED'''
-**** '''Non-selective β antagonists (e.g. propranolol) are associated with ED'''
+** '''β-blockers:'''
-**** '''β1-selective antagonists (e.g. acebutolol) are not associated with ED'''
+*** '''Non-selective β antagonists (e.g. propranolol) are associated with ED'''
-** '''Methyldopa, a centrally acting drug, is associated with ED'''
+*** '''β1-selective antagonists (e.g. acebutolol) are not associated with ED'''
-* '''Psychotropics (antipsychotics, antidepressants, anxiolytics)'''
+* '''Methyldopa, a centrally acting drug, is associated with ED'''
-** '''Commonly produce sexual symptoms'''
-** '''SSRIs'''
+===== Psychotropics (antipsychotics, antidepressants, anxiolytics) =====
-*** '''Up to 50% of patients experience increased sexual dysfunction''', mainly anorgasmia.
+* '''Commonly produce sexual symptoms'''
-**** Adverse effects can be modified by co-treatment with other drugs such as a PDE5 inhibitor or mianserin (atypical antidepressant).
+* '''SSRIs'''
-*** '''Differ in their ability to cause ED'''
+** '''Up to 50% of patients experience increased sexual dysfunction''', mainly anorgasmia.
-**** '''Paroxetine associated with higher rates of ED compared to citalopram'''
+*** Adverse effects can be modified by co-treatment with other drugs such as a PDE5 inhibitor or mianserin (atypical antidepressant).
-** '''Bupropion'''
+** '''Differ in their ability to cause ED'''
-*** '''A norepinephrine-dopamine reuptake inhibitor'''
+*** '''Paroxetine associated with higher rates of ED compared to citalopram'''
-*** '''An alternative antidepressant that is not associated with ED'''
+* '''Bupropion'''
-**** Addition of bupropion or a PDE5 inhibitor to an antidepressant seems to be an effective method to correct antidepressant-associated ED
+** '''A norepinephrine-dopamine reuptake inhibitor'''
-** '''GABAergic drugs - inhibit erection'''
+** '''An alternative antidepressant that is not associated with ED'''
-** '''Tricyclics - orgasmic dysfunction and inhibit ejaculation'''
+*** Addition of bupropion or a PDE5 inhibitor to an antidepressant seems to be an effective method to correct antidepressant-associated ED
-** '''Monoamine oxidase inhibitors - orgasmic dysfunction'''
+* '''GABAergic drugs - inhibit erection'''
-** '''Benzodiazepines - higher rate of sexual dysfunction'''
+* '''Tricyclics - orgasmic dysfunction and inhibit ejaculation'''
-* '''Antiandrogens'''
+* '''Monoamine oxidase inhibitors - orgasmic dysfunction'''
-** Cause partial or near-complete blockade of androgen’s action by inhibiting production of or antagonizing the androgen receptor
+* '''Benzodiazepines - higher rate of sexual dysfunction'''
-** '''The effects of androgen deficiency on sexual activity are variable, ranging from complete loss to normal function'''
-** '''The 5α-reductase inhibitors, finasteride and dutasteride, are the antiandrogens with the least effect on circulating testosterone'''
+===== Antiandrogens =====
-*** '''In randomized placebo-controlled studies of patients given finasteride (5 mg daily) for prostatic symptoms, approximately 5% complained of decreased desire and ED compared with 1% in the placebo group;''' at the lower dose used to treat male-pattern alopecia (1 mg daily), no sexual dysfunction was seen.  However, persistent sexual dysfunction, characterized by low libido, ED, decreased arousal, and difficulty with orgasm, has been reported for months to years after discontinuation of finasteride for hair loss
+* Cause partial or near-complete blockade of androgen’s action by inhibiting production of or antagonizing the androgen receptor
-** '''LHRH antagonists or agonists results in a profound loss of sexual desire, which is usually accompanied by ED'''
+* '''The effects of androgen deficiency on sexual activity are variable, ranging from complete loss to normal function'''
-* '''Anticonvulsants'''
+* '''The 5α-reductase inhibitors, finasteride and dutasteride, are the antiandrogens with the least effect on circulating testosterone'''
-** Carbamazepine - orgasmic dysfunction
+** '''In randomized placebo-controlled studies of patients given finasteride (5 mg daily) for prostatic symptoms, approximately 5% complained of decreased desire and ED compared with 1% in the placebo group;''' at the lower dose used to treat male-pattern alopecia (1 mg daily), no sexual dysfunction was seen.  However, persistent sexual dysfunction, characterized by low libido, ED, decreased arousal, and difficulty with orgasm, has been reported for months to years after discontinuation of finasteride for hair loss
-** Valproate - loss of sexual desire
+* '''LHRH antagonists or agonists results in a profound loss of sexual desire, which is usually accompanied by ED'''
-* '''Miscellaneous drugs'''
-** Generally based on anecdotal case reports or post-marketing drug alerts rather than controlled trials.
+===== '''Anticonvulsants''' =====
-** '''Digoxin'''
+* Carbamazepine - orgasmic dysfunction
-** Statins: underlying disease process appears to be the cause of ED in men treated rather than the drug itself
+* Valproate - loss of sexual desire
-** Sexual dysfunction is a common event after the introduction of '''antiretroviral therapy'''. Because these patients may have diseases involving several organ systems and may be taking multiple drugs, the precise mechanism is difficult to determine.
-** '''Alcohol''' in small amounts improves erection and sexual drive due to its vasodilatory effect and suppression of anxiety; however, large amounts can cause central sedation, decreased libido, and transient ED
+===== Miscellaneous drugs =====
+* Generally based on anecdotal case reports or post-marketing drug alerts rather than controlled trials.
+* '''Digoxin'''
+* Statins: underlying disease process appears to be the cause of ED in men treated rather than the drug itself
+* Sexual dysfunction is a common event after the introduction of '''antiretroviral therapy'''. Because these patients may have diseases involving several organ systems and may be taking multiple drugs, the precise mechanism is difficult to determine.
+* '''Alcohol''' in small amounts improves erection and sexual drive due to its vasodilatory effect and suppression of anxiety; however, large amounts can cause central sedation, decreased libido, and transient ED
 ==== Vascular ====