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The bladder neck closes tightly to prevent retrograde ejaculation, and the external urethral sphincter relaxes. Semen is ejaculated in a pulsatile fashion as a result of rhythmic contractions of the bulbocavernosus muscles (Figure 27). Page 20 Pathophysiology of erectile dysfunction Given the complexity of the system, it is not surprising that a wide variety of diverse disorders may result in erectile dysfunction (Table 1). Often, the cause is multifactorial, but vasculogenic causes are the most commonly implicated.

Even insertion of a penile prosthesis may be technically difficult in such cases because the fibrosis renders dilatation of the corporeal space problematical. PSYCHOGENIC CAUSES Psychological causes were once widely assumed to be the predominant cause of erectile dysfunction. However, if the correct definition of erectile dysfunction is applied, namely, the persistent loss of penile rigidity in all circumstances, then psychogenic erectile dysfunction proves to be less common than its organic counterpart, especially in older men.

Page 24 Epidemiology of erectile dysfunction Ever since the ground-breaking work of Kinsey, the prevalence of erectile dysfunction has been a subject of debate. Although it is certain that many millions of men are affected by the condition, there is a surprising dearth of high-quality epidemiological data with which to quantify accurately the extent of the problem. A figure of one man in ten has often been quoted as an estimate of the prevalence of erectile dysfunction, but the frequency and severity of the disorder vary markedly with age.

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