Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Abnormal endothelial function in ED patients with normal nocturnal penile tumescence and rigidity: is it the role of psychogenic factors?

Abstract

Underlying endothelial dysfunction (EnD) may present in the early stage of ED or psychogenic ED. We retrospectively evaluated 191 ED patients with effective nocturnal penile tumescence and rigidity (NPTR) recording, including detailed medical and psychosexual history, International Index of Erectile Function-5 and vascular parameter. All patients were allocated into psychogenic and organic groups according to the NPTR test. Brachial artery flow-mediated dilation (FMD) was used to diagnose EnD, and ED patients were classified into two groups: non-EnD (FMD10) and EnD (FMD<10). General and vascular parameters were compared between psychogenic and organic groups, and non-EnD and EnD groups with ED were compared in terms of NPTR parameters. In all, 48.7% and 51.3% patients were diagnosed as psychogenic and organic ED, respectively. 73.1% of the psychogenic patients had EnD and 39.8% organic patients had normal endothelial function. In all parameters, only the FMD value showed significant difference between psychogenic and organic ED groups (8.26±2.57 vs 9.16±2.76, P=0.020). No statistical difference was founded in NPTR parameters between non-EnD and EnD groups (P>0.05). In conclusion, NPTR cannot effectively identify the underlying vasculogenic ED from psychogenic ED. Psychogenic causes may cause or aggravate EnD in these ED patients with normal NPTR.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hackett G, Kell P, Ralph D, Dean J, Price D, Speakman M et al. British society for sexual medicine guidelines on the management of erectile dysfunction. J Sex Med 2008; 5: 1841–1865.

    Article  Google Scholar 

  2. Elhanbly S, Elkholy A, Elbayomy Y, Elsaid M, Abdel-gaber S . Nocturnal penile erections: the diagnostic value of tumescence and rigidity activity units. Int J Impot Res 2009; 21: 376–381.

    Article  CAS  Google Scholar 

  3. Karacan I, Hursch CJ, Williams RL . Some characteristics of nocturnal penile tumescence in elderly males. J Gerontol 1972; 27: 39–45.

    Article  CAS  Google Scholar 

  4. Fisher C, Schiavi RC, Edwards A, Davis DM, Reitman M, Fine J . Evaluation of nocturnal penile tumescence in the differential diagnosis of sexual impotence: A quantitative study. Arch Gen Psychiatry 1979; 36: 431–437.

    Article  CAS  Google Scholar 

  5. Bradley WE, Timm GW, Gallagher JM, Johnson BK . New method for continuous measurement of nocturnal penile tumescence and rigidity. Urology 1985; 26: 4–9.

    Article  CAS  Google Scholar 

  6. Meuleman EJH, Hatzichristou D, Rosen RC, Sadovsky R . Diagnostic tests for male erectile dysfunction revisited. J Sex Med 2010; 7: 2375–2381.

    Article  Google Scholar 

  7. Huang Y, Sun X, Liu G, Yao F, Zheng F, Dai Y et al. Glycosylated serum protein may improve our ability to predict endothelial and erectile dysfunction in nonorganic patients. J Sex Med 2011; 8: 840–850.

    Article  Google Scholar 

  8. Vardi Y, Dayan L, Apple B, Gruenwald I, Ofer Y, Jacob G . Penile and systemic endothelial function in men with and without erectile dysfunction. Eur Urol 2009; 55: 979–985.

    Article  Google Scholar 

  9. Deanfield JE, Halcox JP, Rabelink TJ . Endothelial function and dysfunction: testing and clinical relevance. Circulation 2007; 115: 1285–1295.

    Article  Google Scholar 

  10. Bots ML, Westerink J, Rabelink TJ, de Koning EJP . Assessment of flow-mediated vasodilatation (FMD) of the brachial artery: effects of technical aspects of the FMD measurement on the FMD response. Eur Heart J 2005; 26: 363–368.

    Article  Google Scholar 

  11. Moens AL, Goovaerts I, Claeys MJ, Vrints CJ . Flow-mediated vasodilation*. Chest 2005; 127: 2254–2263.

    Article  Google Scholar 

  12. Levine LA, Lenting EL . Use of nocturnal penile tumescence and rigidity in the evaluation of male erectile dysfunction. Urol Clin North Am 1995; 22: 775–788.

    CAS  PubMed  Google Scholar 

  13. Yaman O, Tokatli Z, Ozdiler E, Anafarta K . Effect of aging on quality of nocturnal erections: evaluation with NPTR testing. Int J Impot Res 2004; 16: 150–153.

    Article  CAS  Google Scholar 

  14. Schober JM, Pfaff D . The neurophysiology of sexual arousal. Best Pract Res Clin Endocrinol Metab 2007; 21: 445–461.

    Article  CAS  Google Scholar 

  15. Bella AJ, Brant WO, Lue TF . Physiology of penile erection and pathophysiology of erectile dysfunction. Color Doppler US of the Penis 2008; Chapter 3: 15–20.

    Article  Google Scholar 

  16. Aversa A, Sarteschi LM . The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med 2007; 4: 1437–1447.

    Article  Google Scholar 

  17. Seftel AD . Diagnosis of erectile dysfunction. Stand Pract Sex Med 2006; Chapter 6: 59–74.

    Article  Google Scholar 

  18. Jannini EA, Granata AM, Hatzimouratidis K, Goldstein I . Use and abuse of Rigiscan in the diagnosis of erectile dysfunction. The Journal of Sex Med 2009; 6: 1820–1829.

    Article  Google Scholar 

  19. Costa C, Virag R . The endothelial–erectile dysfunction connection: an essential update. J Sex Med 2009; 6: 2390–2404.

    Article  CAS  Google Scholar 

  20. Kovacs I, Csaszar A, Toth J, Siller G, Farkas A, Tarjan J et al. Correlation between flow-mediated dilation and erectile dysfunction. J Cardiovasc Pharmacol 2008; 51: 148–153.

    Article  CAS  Google Scholar 

  21. Lojanapiwat B, Weerusawin T, Kuanprasert S . Erectile dysfunction as a sentinel marker of endothelial dysfunction. Singapore Med J 2009; 50: 698–701.

    CAS  PubMed  Google Scholar 

  22. Aversa A, Bruzziches R, Francomano D, Natali M, Gareri P, Spera G . Endothelial dysfunction and erectile dysfunction in the aging man. Int J Urol 2010; 17: 38–47.

    Article  Google Scholar 

  23. Halcox JPJ, Donald AE, Ellins E, Witte DR, Shipley MJ, Brunner EJ et al. Endothelial function predicts progression of carotid intima-media thickness. Circulation 2009; 119: 1005–1012.

    Article  Google Scholar 

  24. Foresta C, Caretta N, Corona G, Fabbri A, Francavilla S, Jannini E et al. Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchart. Int J Androl 2009; 32: 198–211.

    Article  CAS  Google Scholar 

  25. Basar MM, Atan A, Tekdogant UY . New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: Is it a useful test? Int J Urol 2001; 8: 686–691.

    Article  CAS  Google Scholar 

  26. Jannini EA, McCabe MP, Salonia A, Montorsi F, Sachs BD . Controversies in sexual medicine: organic vs psychogenic? The Manichean diagnosis in sexual medicine. J Sex Med 2010; 7: 1726–1733.

    Article  Google Scholar 

  27. von Känel R . Psychosocial stress and cardiovascular risk–current opinion. Atherosclerosis 2012; 13: 14.

    Google Scholar 

  28. Toda N, Nakanishi-Toda M . How mental stress affects endothelial function. Pflügers Arch 2011; 462: 779–794.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Professor Yuan-yuan Zhang and Ching-Shwun Lin for the great efforts on revising the manuscript. This study was supported by the grant of National Natural Science Foundation of China (30872571, 81070488, Professor Deng received a grant from NSFC; 30901487, Professor Sun received a grant from NSFC), Guangdong Natural Science Fund (07001628, 10251008901000005, Professor Deng received a grant from GDNSFC; 8451008901000774, Professor Sun received a grant from GDNSFC; 10151008901000222, Dr Deng received a grant from GDNSFC); Guangdong Province Science and Technology Project (2011B031800115, Professor Deng received a grant from GDSTC; 2008B080703056, Professor Liu received a grant from GDSTC; 2009B030801178, Dr Deng received a grant from GDSTC) the grant of Research Fund for the Doctoral Program of Higher Education of China (20100171110060, Professor Deng received a grant from RFDP).

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to X-Z Sun or C-H Deng.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huang, YP., Zhang, YD., Gao, Y. et al. Abnormal endothelial function in ED patients with normal nocturnal penile tumescence and rigidity: is it the role of psychogenic factors?. Int J Impot Res 24, 247–250 (2012). https://doi.org/10.1038/ijir.2012.26

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2012.26

Keywords

Search

Quick links