An Atlas of Erectile Dysfunction, Second Edition by Roger S. Kirby

By Roger S. Kirby

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It then runs distally along the dorsal penile shaft lateral to the dorsal artery. Multiple fascicles fan out distally, supplying proprioceptive and sensory nerve terminals to the dorsum of the tunica albuginea and skin of the penile shaft and glans penis. CENTRAL NERVOUS SYSTEM CONNECTIONS Although reflex spinal erections may occur provided that the sacral reflexes are intact (for example, after cervical or thoracic spinal injury), central connections are paramount in engendering the normal male Page 16 sexual response.

Psychosexual counseling is most effective when the problem is due to technique or there are unrealistic expectations on one or both sides of the relationship. As already mentioned; severe relationship problems are a potent source of erectile dysfunction, and these may sometimes be resolved through counseling. The most commonly employed approach is that pioneered in 1970 by Masters and Johnson. Briefly this involves a program that aims to: (1) Understand the problem; (2) Establish relearning of sexual behavior; (3) Remove anxiety; (4) Teach communication skills; (5) Redefine success; and (6) Teach permission giving.

It is my hoped-for intention that this second edition of the atlas will provide clinicians with easy access to the information that they require to bring up the subject with their patients and alleviate the often considerable anxiety and distress endured not only by the many men afflicted by erectile dysfunction, but by their partners as well. Kirby London Page 10 This page intentionally left blank. Page 11 Section I: A Review of Erectile Dysfunction Introduction 13 Anatomy 14 Arterial blood supply 14 Venous drainage 15 Lymphatic drainage 15 Neuroanatomy 15 Central nervous system connections 15 Mechanisms of erection 17 Regulation of intracavernosal smooth muscle contractility 18 Adrenergic vasoconstrictor mechanisms 18 Cholinergic mechanisms 18 Non-adrenergic non-cholinergic mechanisms 18 Endothelial mechanisms 18 Hemodynamics of erection 19 Orgasm and ejaculation 19 Pathophysiology of erectile dysfunction 20 Vasculogenic causes 20 Neurogenic causes 21 Endocrinological causes 22 Priapism and postpriapism erectile dysfunction 23 Psychogenic causes 23 Epidemiology of erectile dysfunction 24 Risk factors for erectile dysfunction 25 Diabetes mellitus 25 Hypertension 25 Hyperlipidemia 25 Smoking 25 Peyronie’s disease 25 Previous surgery 26 Depression 26 Page 12 Diagnosis of erectile dysfunction 27 History 27 Physical examination 28 Special investigations 29 Treatment options for erectile dysfunction 31 Psychosexual counseling 31 Medical therapies 31 Vacuum devices 34 Surgical therapies 34 Conclusions 36 Bibliography 37 Appendix 41 Page 13 Introduction Until recently, a man unable to develop or sustain an erection sufficient for penetrative sexual intercourse has been referred to as ‘impotent’.

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