Erectile dysfunction in multiple sclerosis

Abstract

In a sample of 29 impotent men with multiple sclerosis and erectile problems, penile arterial inflow and venous outflow were within normal limits. In 26 patients, the pudendal evoked potential (PEP) was abnormal, and eight of these also had abnormal bulbocavernous reflex (BCR). Three patients had abnormal PEP and normal BCR, and of these, two had normal and one had abnormal nocturnal erectile activity. The validity of PEP/BCR testing was supported by normal findings in six patients with MS and without erectile problems. Nocturnal erectile activity was normal in 11 patients, of whom nine had abnormal PEP and/or BCR. A high disability score corresponded poorly with both reduced sexual function, insufficient nocturnal erectile activity, and abnormal PEP and/or BCR. Intracavernous injection of papaverine gave erection in 27 patients, the dose needed to create an erection being inversely related to the level of disablement. PEP and BCR testing may be more sensitive in defining neurogenic erectile dysfunction (ED) than nocturnal erectile activity. We considered 26 of the cases to have a neurogenic cause of ED and three to have mainly a psychogenic cause.

Role of Penile Nocturnal Tumescence and Rigidity Measurement in the Diagnosis of Erectile Impotence

“…The other 2 abnormal evaluations were found in a patient with adrenomyeloneuropathy and in a patient with stenosis of the spinal canal. We came to the same conclusion as Kirkeby [9].…”

Sexual Dysfunction in Patients with Neurological Disorders

“…It has been shown that intracavernous injection of papaverine gives erection in almost all multiple sclerosis patients with erectile dysfunction (Kirkeby et al, 1988). Insufficient arterial inflow or venous outflow problems do not appear to be involved (Kirkeby et al).…”

“…Pathological bulbocavernosal, or anal sphincter reflexes, or ab normal pudendal evoked potentials (Bemelmans et al,1991;Kirkeby et al, 1988;Vas, 1969), as well as pathological urodynamic findings or reduced urethral sensitivity thresholds (Brekkan et al, 1988;Lundberg et al, 1982;Rydin et al,1981), give further evidence of involvement of those parts of the nervous system controlling pelvic floor structures.…”

Changes in Erectile Response to Repeated Audiovisual Sexual Stimulation

“…However, this test is time-consuming, cumbersome, relatively expensive, and its result can be affected by psychological factors, sleep disorders, drugs taken, and hypogonadism [1, 2, 3, 4, 5, 6, 7]. In addition, adequate nocturnal erection may be observed in patients with organic impotence, especially in patients with neurogenic impotence [8]. Furthermore, it remains unclear whether the result of a nocturnal penile erection test is a valid indicator of erectile potential in erotic and sexual circumstances [9].…”