Significant scientific advances during the past 3 decades have deepened our understanding
of the physiology and pathophysiology of penile erection. A critical evaluation of
the current state of knowledge is essential to provide perspective for future research
and development of new therapies.
To develop an evidence-based, state-of-the-art consensus report on the anatomy, physiology,
and pathophysiology of erectile dysfunction (ED).
Consensus process over a period of 16 months, representing the opinions of 12 experts
from seven countries.
Expert opinion was based on the grading of scientific and evidence-based medical literature,
internal committee discussion, public presentation, and debate.
ED occurs from multifaceted, complex mechanisms that can involve disruptions in neural,
vascular, and hormonal signaling. Research on central neural regulation of penile
erection is progressing rapidly with the identification of key neurotransmitters and
the association of neural structures with both spinal and supraspinal pathways that
regulate sexual function. In parallel to advances in cardiovascular physiology, the
most extensive efforts in the physiology of penile erection have focused on elucidating
mechanisms that regulate the functions of the endothelium and vascular smooth muscle
of the corpus cavernosum. Major health concerns such as atherosclerosis, hyperlipidemia,
hypertension, diabetes, and metabolic syndrome (MetS) have become well integrated
into the investigation of ED.
Despite the efficacy of current therapies, they remain insufficient to address growing
patient populations, such as those with diabetes and MetS. In addition, increasing
awareness of the adverse side effects of commonly prescribed medications on sexual
function provides a rationale for developing new treatment strategies that minimize
the likelihood of causing sexual dysfunction. Many basic questions with regard to
erectile function remain unanswered and further laboratory and clinical studies are