By Roger S. Kirby
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Extra resources for An Atlas of Erectile Dysfunction, Second Edition (Encyclopedia of Visual Medicine)
As a result of the loss of tunica elasticity, Peyronie’s disease may also be associated with venous leak-induced erectile dysfunction. PREVIOUS SURGERY Various forms of pelvic surgery, particularly radical prostatectomy, cystoprostatectomy and abdominoperineal resection, are all strongly associated with subsequent erectile dysfunction. DEPRESSION Reactive or endogenous depression is strongly associated with erectile dysfunction: nearly 90% of severely depressed men report complete impotence. Treatment with antidepressants may sometimes improve the situation, although both monoamine oxidase inhibitors and tricyclic antidepressants may in themselves cause erectile dysfunction.
Increased sympathetic vasoconstrictor tone and raised circulating norepinephrine levels are most probably involved. Psychogenic factors also come into play in other forms of erectile dysfunction, as failure of erection itself induces anxiety, loss of confidence and sometimes relationship difficulties. The conviction that an erection will not develop when required, therefore, becomes a self-fulfilling prophesy. Page 24 Epidemiology of erectile dysfunction Ever since the ground-breaking work of Kinsey, the prevalence of erectile dysfunction has been a subject of debate.
Cavernosal filling compresses the obliquely running subtunical venules against the sturdy tunica albuginea, resulting in a hundred-fold increase in resistance to venous outflow (Figure 25). Intracavernosal blood pressure soon rises to approximate that of systolic blood pressure, thereby producing penile erection (Figure 26). ORGASM AND EJACULATION Orgasm and ejaculation are the result of a sudden increase in sympathetic efferent activity. This has a number of effects: the prostate, seminal vesicles and vasa deferentia contract, emptying their contents into the prostatic urethra.