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Central mechanisms of erectile dysfunction: what a clinician may want to know

International Journal of Impotence Research volume 15, pages S3–S6 (2003)Cite this article

Abstract

The interplay between peripheral and central mechanisms of erectile function are not fully elucidated although basic science is moving ahead in this area. It is important from a clinical point of view to understand these mechanisms so that we may begin to make further therapeutic advances in the treatment of erectile dysfunction (ED). It is now widely understood that central disinhibition plays a crucial role in the induction of erectile responses and this has led to the development of the central initiator, apomorphine SL (Ixense™) [apo SL]. Apo SL acts in the paraventricular nucleus of the hypothalamus as a dopamine receptor agonist. It works as a proerectile conditioner at this level to increase the responses of the erectile pathway following appropriate sexual stimulation. This unique central mode of action of apo SL has thus proved efficacious in approximately 70% of ED patients although persistence may be required to produce a robust effect for the maximum number of patients.

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References

  1. McKenna KE . Central control of penile erection. Int J Impot Res 1998; 10(Suppl 1): S25–S34.

    PubMed  Google Scholar 

  2. Numan M . Neural basis of maternal behavior in the rat. Psychoneuroendocrinology 1988; 13: 47–62.

    Article  CAS  PubMed  Google Scholar 

  3. Kanosue K, Zhang YH, Yanase-Fujiwara M, Hosono T . Hypothalamic network for thermoregulatory shivering. Am J Physiol 1994; 267: R275–R282.

    CAS  PubMed  Google Scholar 

  4. Bourque CW, Oliet SH, Richard D . Osmoreceptors, osmoreception, and osmoregulation. Front Neuroendocrinol 1994; 15: 231–274.

    Article  CAS  PubMed  Google Scholar 

  5. Eaton RC et al. D2 receptors in the paraventricular nucleus regulate genital responses and copulation in male rats. Pharmacol Biochem Behav 1991; 39: 177–181.

    Article  CAS  PubMed  Google Scholar 

  6. Chen KK, Chan SH, Chang LS, Chan JY . Participation of paraventricular nucleus of hypothalamus in central regulation of penile erection in the rat. J Urol 1997; 158: 238–244.

    Article  CAS  PubMed  Google Scholar 

  7. Buijs RM, Geffard M, Pool CW, Hoorneman EM . The dopaminergic innervation of the supraoptic and paraventricular nucleus. A light and electron microscopical study. Brain Res 1984; 323: 65–72.

    Article  CAS  PubMed  Google Scholar 

  8. Marson L, McKenna KE . The identification of a brainstem site controlling spinal sexual reflexes in male rats. Brain Res 1990; 515: 303–308.

    Article  CAS  PubMed  Google Scholar 

  9. Marson L, McKenna KE . A role for 5-hydroxytryptamine in descending inhibition of spinal sexual reflexes. Exp Brain Res 1992; 88: 313–320.

    Article  CAS  PubMed  Google Scholar 

  10. Giuliano FA, Rampin O, Benoit G, Jardin A . Neural control of penile erection. Urol Clin North Am 1995; 22: 747–766.

    CAS  PubMed  Google Scholar 

  11. Andersson KE, Hedlund P, Alm P . Sympathetic pathways and adrenergic innervation of the penis. Int J Impot Res 2000; 12: S5–S12.

    Article  CAS  PubMed  Google Scholar 

  12. Wagner G, Mulhall J . Pathophysiology and diagnosis of male erectile dysfunction. BJU Int 2001; 88(Suppl 3): 3–10.

    Article  PubMed  Google Scholar 

  13. Argiolas A, Hedlund H . The pharmacology and clinical pharmacokinetics of apomorphine SL. BJU Int 2001; 88(Suppl 3): 18–21.

    Article  CAS  PubMed  Google Scholar 

  14. Chen KK, Chan JY, Chang LS . Dopaminergic neurotransmission at the paraventricular nucleus of hypothalamus in central regulation of penile erection in the rat. J Urol 1999; 162: 237–242.

    Article  CAS  PubMed  Google Scholar 

  15. Rampin O . Mode of action of a new oral treatment for erectile dysfunction: apomorphine SL. BJU Int 2001; 88(Suppl 3): 22–24.

    Article  CAS  PubMed  Google Scholar 

  16. Mirone VG, Stief CG . Efficacy of apomorphine SL in erectile dysfunction. BJU Int 2001; 88(Suppl 3); 25–29.

    Article  CAS  PubMed  Google Scholar 

  17. Altwein JE, Keuler FU . Oral treatment of erectile dysfunction with apomorphine SL. Urol Int 2001; 67: 257–263.

    Article  CAS  PubMed  Google Scholar 

  18. Heaton JP, Dean J, Sleep DJ . Sequential administration enhances the effect of apomorphine SL in men with erectile dysfunction. Int J Impot Res 2002; 14: 61–64.

    Article  CAS  PubMed  Google Scholar 

  19. Gerstenberg T, Hedlund H In: Graugaard C, Hertoft P, Møhl B (eds.). Hjerne & Seksualitet: Aspekter af Teori & klinik. Munksgaard, 1997.

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Authors and Affiliations

  1. Department of Urology, Medical School Hannover, Hannover, Germany

    C G Stief

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  1. C G Stief
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Correspondence to C G Stief.

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Stief, C. Central mechanisms of erectile dysfunction: what a clinician may want to know. Int J Impot Res 15 (Suppl 2), S3–S6 (2003). https://doi.org/10.1038/sj.ijir.3900989

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  • DOI: https://doi.org/10.1038/sj.ijir.3900989

Keywords

  • erectile dysfunction
  • aetiology
  • apomorphine SL
  • efficacy

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