Disfunci N Er Ctil

Disfunción Eréctil Orgánico

Wein: Campbell-Walsh Urology, 9th ed.
Copyright © 2007 Saunders, An Imprint of Elsevier

Organic   I.    Vasculogenic
  
Arteriogenic
  
Cavernosal
Wein: Campbell-Walsh Urology, 9th ed.
  
Mixed
Copyright ©
  II.  Neurogenic
2007 Saunders, An Imprint of Elsevier
  III.  Anatomic
  IV.  Endocrinologic
Psychogenic
  I.    Generalized   
A.    Generalizedunresponsiveness   
1.    Primary lack of sexual arousability
  2.    Aging-related decline in sexual arousability
 B.    Generalized inhibition   1.    Chronic disorder of sexual intimacy
  II.  Situational   A.    Partner-related   
1.    Lack of arousability in specifc relationship
  2.    Lack of arousability owing to sexual object preference
  3.    High central inhibition owing to partner confict orthreat
  B.    Performance-related   1.    Associated with other sexual dysfunction/s (e.g.,
rapid ejaculation)
  2.    Situational performance anxiety (e.g., fear of failure)
  C.    Psychological distress- or adjustment-related   1.    Associated with negative
mood state (e.g., depression) or major life stress (e.g., death of partner)

Endocrinológico
• Hypogonadism is a not-infrequent fnding inthe impotent population.
Androgens infuence the growth and development of the male reproductive
tract and secondary sex characteristics; their effects on libido and sexual
behavior are well established. In a review of published articles from 1975 to
1992, Mulligan and Schmitt, (1993) concluded that testosterone
• (1) enhances sexual interest,
• (2) increases the frequency of sexual acts, and
• (3)increases the frequency of nocturnal erections but has little or no effect
on fantasy-induced or visually stimulated erections.Granata
and coworkers (1997)
• have reported that the threshold level of testosterone for normal nocturnal
erections is about 200 ng/dL. However, exogenous testosterone therapy in
impotent men with borderline-low testosterone levels reportedly has little
effect (Graham andRegan, 1992).

Endocrinológico
• Any dysfunction of the hypothalamic-pituitary axis can result in
hypogonadism. Hypogonadotropic hypogonadism can be
congenital or caused by a tumor or injury; hypergonadotropic
hypogonadism may result from a tumor, injury, surgery, or
mumps orchitis.
• Hyperprolactinemia, whether from a pituitary adenoma or
drugs, results in both reproductive and sexualdysfunction.
Symptoms may include loss of libido, ED, galactorrhea,
gynecomastia, and infertility. Hyperprolactinemia is associated
with low circulating levels of testosterone, which appear to be
secondary to inhibition of gonadotropin-releasing hormone
secretion by the elevated prolactin levels.

Endocrinológico
• ED may also be associated with both hyper- and
hypothyroidism. The former is commonlyassociated with
diminished libido (which may be caused by the increased
circulating estrogen levels) and less often with ED. In
hypothyroidism, low testosterone secretion and elevated
prolactin levels contribute to ED.
• Diabetes mellitus, although the most common
endocrinologic disorder, causes ED through its vascular,
neurologic, endothelial, and psychogenic complications
rather than through hormonedeficiency per se. A
detailed discussion is given later in this chapter.

Alteraciones Sexuales Inducidas
por Medicamentos

ANTIHIPERTENSIVOS.
•
Los antihipertensivos producen interferencias en el funcionamiento
sexual más frecuentemente que cualquier otro grupo farmacológico.
La incidencia de estos trastornos es especialmente difícil de evaluar ya
que es mayor en pacientes hipertensos tratadosque en controles
normales, pero es indudable que los antihipertensivos incrementan la
frecuencia de disfunción sexual en pacientes hipertensos.
• Diuréticos
• Tiazidas y afines
– podría deberse a efectos directos en el músculo liso
– por disminución de la respuesta a la dopamina
– reducción del volumen extracelular o depleción de zinc que produciría una
reducción en la producción de testosterona...