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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The signs and symptoms of ED include difficulty in attaining or keeping and erection, and reduced sexual desire. Retrograde ejaculation is signified by semen going into the bladder instead of being ejaculated out of the body. An affected male may experience dry orgasms, cloudy urine after orgasm, and infertility. With decreased vaginal lubrication, the sexual dyspareunia may develop since lack of sufficient lubrication may result in various degrees of pain during intercourse.
Erectile Dysfunction
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Mark Johnson, Marco Falcone, Tarek M. A. Aly, Amr Abdel Raheem
ED is a common condition associated with a variety of risk factors. In addition to improving the quality of erections (ED-specific treatment), it is also important to manage the ED risk factors such as smoking, obesity, and hyperlipidemia; insulin resistance and diabetes; and hypogonadism and uncontrolled blood pressure. Management of these risk factors will improve patients’ response to the ED-specific treatment and is important for the overall health and well-being of these patients.
Physical Aspects of the Sex Response
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
Erection is primarily a neurovascular cascade phenomenon, with an underlying mechanism of smooth muscle relaxation in the corpus cavernosae of the penis or clitoris (see Figure 5.5). Sexual stimulation results in an increase in pelvic parasympathetic activity, with a resultant release of neurotransmitters (primarily nitric oxide [NO]) from cavernous nerve terminals and endothelial cells. The increased NO levels increase the conversion of guanosine triphosphate (GTP) to cyclic guanosine monophosphate (cGMP) via activation of a soluble enzyme (guanyl cyclase [GC]), with a resultant block in calcium channels via activation of a cGMP-dependent protein kinase. It is the subsequent fall in intracellular calcium levels within cavernosal smooth muscle cells which accounts for the smooth muscular relaxation allowing increased inflow of blood to cavernosal arteries and arterioles.
A review on pharmacological options for the treatment of erectile dysfunction: state of the art and new strategies
Published in Expert Opinion on Pharmacotherapy, 2023
Mattia Longoni, Alessandro Bertini, Nicolò Schifano, Emanuele Zaffuto, Paolo Maggio, Rossi Piercarlo, Sara Baldini, Giulio Carcano, Gabriele Antonini, Andrea Salonia, Francesco Montorsi, Federico Dehò, Paolo Capogrosso
Prostaglandin E1 (PGE1, also known as alprostadil), is the first and only drug approved for intracavernous (IC) injection for the management of ED (Table 2) [59]. As with other intracavernosal agents, its mechanism of action does not rely on an intact nerve supply. Therefore, whenever penile vascularization is preserved, an erection could occur. After binding with G-protein-coupled receptors (mainly EP2 and EP4), PGE1 induces relaxation of smooth muscle in the corpora cavernosa and subsequent vasodilatation by increasing cyclic adenosine monophosphate (cAMP) synthesis [8]. In addition, PGE1 causes an α-adrenoceptor-mediated inhibition of noradrenaline release, reinforcing vasodilatation and inducing veno-occlusion [60]. The erection generally appears after 5–15 minutes and lasts according to the dose injected, but with substantial discrepancy among patients [55].
Recent advances in stem cell therapy for erectile dysfunction: a narrative review
Published in Expert Opinion on Biological Therapy, 2023
Bohan Wang, Wenjun Gao, Micha Y. Zheng, Guiting Lin, Tom F Lue
In addition to clinical research with stem cells for ED, a prospective study involving a stem cell-derived product was conducted. Schwarz et al. (2021) evaluated the efficacy and life quality of patients who received treatment with stem cell-derived bioactive molecules (NCT04684602) [64]. The stem cell-derived product used in this study was a highly concentrated acellular solution sourced from umbilical cord tissue without blood cells or blood products. Twenty self-reported ED men were treated with 2 mL of aliquot PrimeProTM (Thoms Advanced Medical, Los Angeles, CA), while six more ED patients received 2 ml of saline as a control group. IIEF-5 scores, blood pressure, heart rate, six-minute walk test (6MWT), and the short-form 36 quality of life questionnaire (SF-36) results were recorded at baseline and followed up for six months. The IIEF-5 scores of the treatment group improved from 12.9 ± 4.27 at baseline to 18 ± 3.37, while no difference in IIEF scores was observed in the control group. All 20 patients in the treatment group reported improved erections, including erectile capabilities and improved intercourse success. Significant improvements were also observed in the SF-36 scores. Although the duration of action may be short due to easy exit from the corpora cavernosa, the stem cell-derived bioactive molecules from umbilical cord tissue without blood cells or blood products can become an off-the-shelf ED therapy if proven to be effective.
Evaluation of the effects of chronic stress applied from the prepubertal to the adult stages or only during adulthood on penile morphology in rats
Published in Stress, 2019
Carina Teixeira Ribeiro, Waldemar Silva Costa, Francisco José Barcellos Sampaio, Marco Aurélio Pereira Sampaio, Diogo Benchimol de Souza
Penile erection involves various complex neuroendocrine, vascular, and structural mechanisms. Basically, an erection occurs by distension of the cavernosal sinusoidal smooth muscle, followed by a subsequent increase in arterial blood flow and venous occlusion (van Driel, 2015). Therefore, impairment of any of these factors can result in erectile dysfunction. Chronic stress in rats has been reported to reduce levels of testosterone (de Souza et al., 2012), a hormone that plays an important role in the modulation and maintenance of penile structures, as well as in the neuroendocrine and vascular mechanisms that maintain erectile function (Traish, 2009). Structural changes, such as smooth muscle reduction, increased fibrosis, and endothelial and nerve dysfunction in the penile corpus cavernosum, were associated with suppression of testosterone levels in men and laboratory animals (Miranda, Gallo, De Souza, Costa, & Sampaio, 2012; Wang et al., 2015; Blick, Ritchie, & Sullivan, 2016). These changes were found to be correlated with erectile dysfunction (Costa, Carrerete, Horta, & Sampaio, 2006; Bal et al., 2009; van Driel, 2015).