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Erectile Dysfunction: Endothelial Dysfunction; 113

Emotional Disturbance

pogonadism, Hyerprolactinaemia, Diabetes, Thyroid metabolic, synthetic, anti-inflammatory, and anti-
disease, Androgen deficiency, Excess of Estrogen, thrombogenic processes.
Adrenal, Pitutary or hypothalamic diseases.
To understand the management of erectile dysfunc-
The Neurological Causes of erectile dysfunction in- tion one must understand that a normal vascular and
clude Multiple Sclerosis, Spinal cord injury, Diabetic neuronal endothelium produces endothelial Nitric
Neuropathy. oxide Synthase and neuronal nitric oxide synthase.
eNOS and nNos initate the NO to enter in the corpo-
Drugs which cause erectile dysfunction are Antian- ra cavernosa spongy tissue and converts Guanosine
drogens , Antihypertensives Diuretics, H2 Receptor Monophosphate to Cyclic Guanosine Monophos-
antagonists, Anticholinergics like atropine, proban- phate with the help of an enzyme Gyanylate Cyclase.
thine, dicyclomine, Antidepressants like Tricyclics, This Cyclic GMP is the main chemical which relaxes
MAO inhibitors, Antipsychotics, Antiepileptics and the smooth muscle cell of the Corpora and allows the
Certain Substance of Abuse like Heroin, Marijauna, blood to flow in the penile vasculature
etc.

Certain stresses and psychological factors which
cause erectile dysfunction include fatigue, guilt, low This cGMP also decreases the Calcium influx through
self esteem, body image issues, certain mental dis- specific protein kinases and allows the smooth mus-
orders, and religious restrictions, negative feelings cle relaxation and erections.
towards the partner, resentment, hostility and lack
of trust. But soon cGMP gets hydrolysed to 5 Guanosine mo-
nophosphate with the help of a enzyme Phospho-
Chronic Kidney disease, Prostatectomy can also diastrase 5.
lead to erectile dysfunction.
So for a good enough erection one has to see that
Other common causes include watching too much of the endothelium has to be normal & functional, Ade-
pornography, infertility and stresses of modern life.
quate Nitric Oxide, Guanylate Cyclase Activators and
In India Diabetes is the biggest health tsunami of our Stimulators, cGMP to be present in more bioavaila-
century. There are 417 million diabetics across the bale form to maintain tumusence and lastly some-
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globe and of these one-third are in India either at thing to block the PDE5 enzyme.
diabetic or pre-diabetic stage. India and China are two So in Erectile dysfunction the main cause is endo-
countries in the world where diabetes is an explosive thelial dysfunction as we are aware that a normal
1
epidemic . In fact India and China, let us call it Chin- healthy endothelium produces homeostasis by var-
dia, are the diabetes capital of the worlds. Men and ious mechanisms.
Women with diabetes have sexual problems. The
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commonest complication of diabetes seen in Indian Endothelium is an endocrine organ and plays a
men is Erectile Dysfunction, central role in regulating the vasomotor tone and lo-
cal homeostasis and also controls the coagulation
The last 20 years have established that the vascu- process. Endothelial cells have sensors and release
4
lar endothelium, rather than being a mere barrier be- mediators and these mediators are the functional
tween intravascular and interstitial compartments, is molecules on the cell surgace. The mediators include
a widely spread organ responsible for the regulation Nitric Oxide, cyclooxygenase, endothelin -1, endothe-
of hemodynamics, angiogenic vascular remodeling,
lium dependent factor, prosetenoids, angiotensin,

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