Erectile Dysfunction and Neurological Comorbidities: a Contemporary Review
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MEDICAL COMORBIDITIES (J KOVAC AND O RAHEEM, SECTION EDITORS)
Erectile Dysfunction and Neurological Comorbidities: a Contemporary Review Dyvon T. Walker 1 & Jesse N. Mills 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The goal of this article is to review the major neurologic disorders that can lead to erectile dysfunction (ED) as well as the current management options, highlighting the most recent literature on the subject. Recent Findings Studies suggest that emerging novel therapies may act to supplement the established therapies for neurogenic ED, such as adipose tissue–derived mesenchymal stem cells and focal muscle vibration. Recent studies and meta-analyses also confirm the safety and efficacy of phosphodiesterase type-5 inhibitors (PDE5i) as the first-line therapy for neurogenic ED. Summary Neurological conditions such as multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke can have unique and multifactorial contributions to ED. PDE5i remain the mainstay of treatment for neurogenic ED. Non-pharmacological treatments are also available for patients who desire that option. A multidisciplinary approach is the most effective method of treatment. Keywords Erectile dysfunction . Multiple sclerosis . Parkinson’s disease . Stroke . Neurological disorders
Introduction Neurogenic erectile dysfunction (ED) accounts for 10 to 19% of all causes of ED [1]. Several neurologic disease states may have unique and multifactorial effects on sexual function; thus, it is important to understand how each specifically contributes to ED in order to determine the best treatment strategies. Neurologic diseases exert their influence on sexual function via (1) a primary effect directly impacting the neural pathways, (2) a secondary effect causing muscle weakness, sensory dysfunction, or bladder/bowel dysfunction, or (3) a tertiary effect via psychological or social mechanisms (Table 1) [2–5]. These classifications highlight the importance of addressing all of the issues leading to ED rather than only the neurologic contributions of a specific disorder. This article is part of the Topical Collection on Medical Comorbidities * Jesse N. Mills [email protected] 1
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
2
Division of Andrology, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 10945 Le Conte Avenue, Ueberroth #3361, Los Angeles, CA 90095, USA
The aim of this article is to review the major neurological comorbidities that can lead to ED, as well as to evaluate the existing and novel treatment options.
Neurological Conditions Multiple Sclerosis Multiple sclerosis (MS) is the most common progressive neurologic disease in young adults worldwide, with prevalence in the USA that is steadily increasing [6]. It has been reported that 50–85% of patients with MS experience ED, which can arise at any stage of the disease and is the most commonly reported sexual dysfunct
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