Which nerve erectile dysfunction

High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage blood vessels that provide blood flow to the penis to achieve and maintain an erection. While medications are a common first therapy, they tend to only work in about 50 percent of men with diabetes. Good blood sugar control can help slow the progression of ED and sexual dysfunction in men. Men with diabetes are more likely to move on to other treatment options, such as the:.

Some men notice issues maintaining an erection after starting a new medication. Common medications that can contribute to erectile issues are:. Pelvic surgeries are a common cause of sexual dysfunction.

Erectile dysfunction is a potential complication following prostate cancer surgery. Paraplegia ; 19 : — Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury.

Spinal Cord ; 39 : — Central neural regulation of penile erection. Central regulation of ejaculation. Giuliano F, Clement P. Physiology of ejaculation: emphasis on serotonergic control. Eur Urol ; 48 : — Article PubMed Google Scholar. Neural regulation of the vas deferens in the rat: an electrophysiological analysis.

Kimura Y. On peripheral nerves controlling ejaculation. Tohoku J Exp Med ; : — Kihara K, de Groat WC. Sympathetic efferent pathways projecting bilaterally to the vas deferens in the rat.

Anat Rec ; : — Sympathetic efferent pathways projecting to the bladder neck and proximal urethra in the rat. J Auton Nerv Syst ; 62 : — Motor innervation of the smooth muscle of the rat seminal vesicle. J Pharmacol Exp Ther ; : — Effects of autonomic drugs on contractions of rat seminal vesicles in vivo. J Reprod Fertil ; 70 : — An experimental model to evaluate the in vivo response of rat seminal vesicle to electrical stimulation. Neurosci Lett ; : — Kamischke A, Nieschlag E.

Treatment of retrograde ejaculation and anejaculation. Hum Reprod Update ; 5 : — The effect on erection and orgasm of cystectomy, prostatectomy and vesiculectomy for cancer of the bladder: a clinical and electromyographic study.

Br J Urol ; 51 : — The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int ; 94 : — In vivo evaluation of serotonergic agents and alpha-adrenergic blockers on premature ejaculation by inhibiting the seminal vesicle pressure response to electrical nerve stimulation.

Br J Urol ; 82 : — An in vivo evaluation of the therapeutic potential of sympatholytic agents on premature ejaculation. BJU Int ; 84 : — Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation.

Urology ; 61 : — Download references. You can also search for this author in PubMed Google Scholar. Correspondence to K Everaert.

Reprints and Permissions. Everaert, K. Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves.

Spinal Cord 48, — Download citation. Received : 26 May Revised : 02 November Accepted : 15 November Published : 05 January Issue Date : March Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Clinical Autonomic Research Spinal Cord Series and Cases Nature Reviews Urology Advanced search.

Skip to main content Thank you for visiting nature. Download PDF. Subjects Nervous system Neurological disorders Neurophysiology Sexual dysfunction. Abstract Study design: Review article.

Objectives: The neuroanatomy and physiology of psychogenic erection, cholinergic versus adrenergic innervation of emission and the predictability of outcome of vibration and electroejaculation require a review and synthesis. Setting: University Hospital Belgium.

Methods: We reviewed the literature with PubMed — Results: Erection, emission and ejaculation are separate phenomena and have different innervations. Conclusion: Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Introduction Sexual dysfunction is a complication of neurogenic diseases such as spina bifida, spinal cord injury, or multiple sclerosis, among others and erection is less prone to dysfunction as compared with ejaculation.

Materials and methods We reviewed the literature PubMed — on the neuroanatomy and neurophysiology of erection and ejaculation and on therapy for neurogenic patients and their dysfunctions. Results Erection Introduction Erection is the result of a high parasympathetic and low sympathetic tone resulting in the relaxation of the smooth muscle cells of the corpora cavernosa and the helicine penile arteries. Figure 1. Full size image. Figure 2. Figure 3. Conclusion Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain.

Conflict of interest The authors declare no conflict of interest. Article Google Scholar Download references. View author publications. Rights and permissions Reprints and Permissions. About this article Cite this article Everaert, K. Copy to clipboard. Previnaire , J. Soler , M. Alexander , F. As awareness of the complexities of normal sexual function increase so will the recognition of SD in this population. This movement will lead to improved quality of life in men with neurologic disorders, as proven by the strong link between sexual function and quality of life.

Conflicts of Interest: The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List Transl Androl Urol v. Transl Androl Urol. Anand N. Shridharani 1 and William O. Brant 2. Shridharani 1 Find articles by Anand N. William O.

Brant 2 Find articles by William O. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to: Anand N. Shridharani, MD. Email: gro. Received Nov 5; Accepted Jan 2. Copyright Translational Andrology and Urology. All rights reserved.

This article has been cited by other articles in PMC. Abstract Erectile dysfunction ED related to compromise of the nervous system is an increasingly common occurrence. Keywords: Erectile dysfunction ED , neurogenic, treatment. Introduction Neurogenic erectile dysfunction NED is a traditional classification of erectile dysfunction ED encompassing disorders impairing erections via neurologic compromise or dysfunction.

Neuroanatomy and neurophysiology of erection A comprehensive understanding of the neural pathways for erection is necessary for assessing whether neurogenic ED exists and how to appropriately address the ED. Peripheral pathways Nerves originating in the spinal cord and peripheral ganglia innervate the penis.

Somatic pathways The somatosensory pathways for erections originate in the penile skin, glans and urethra. Supraspinal centers and pathways Erections are initiated and maintained via integration of afferent inputs in the supra sacral regions of the central nervous system. Peripheral neurologic impairment ED may also occur for damage to the peripheral nerves from pelvic and prostate surgery, as well as diabetes mellitus. Epilepsy Sildenafil has been previously suggested as a treatment option for ED in men with epilepsy 77 , Local therapies Intracavernosal injections ICI Intracavenosal therapy involves injection of a vasoactive agent into the corpora cavernosa to effect smooth muscle relaxation and tumescence.

Vasoactive intestinal peptide VIP VIP is a neurotransmitter with regulatory actions on blood flow, secretion and muscle tone with intracorporal adenylate cyclase activation and smooth muscle relaxation. Combination therapy Multiple combinations of intracavernosal therapy exist and the effectiveness of them varies based on patient characteristics and varying dosing strength Table 1.

Table 1 Intracavernosal pharmacotherapies. Open in a separate window. Intraurethral alprostadil Alprostadil may be delivered via the urethra in the form of a pellet MUSE Vacuum erection devices VED VED involved placing the penis in a clear plastic tube where negative pressure created by the vacuum pump leads to penile engorgement and tumescence. Penile implant surgery Prior to the introduction of PDE5i in , intracavernosal vasoactive medications and penile implant surgery were the mainstays of treatment.

Future directions Since the advent of PDE5i, many other selective and non-selective peripheral acting compounds have been developed or are in development.

Acknowledgements None. Footnotes Conflicts of Interest: The authors have no conflicts of interest to declare. References 1. Abicht JH. Testing the autonomic system. Erectile Dysfunction. Berlin: Springer Verlag, The effect of cryosurgical ablation of the prostate on erectile function.

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Neurorehabil Neural Repair ; 3 Sexual dysfunction in Parkinson's disease. This usually interferes with sexual activity. To continue reading this article, you must log in. Already a member? Login ». As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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