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Pathophysiology

Penile erection is controlled by two mechanisms: the reflex erection achieved by rubbing the penile shaft directly, and the psychogenic erection achieved by sexual or emotional stimulation. The former includes the peripheral nerves and the lower portions of the spinal cord, while the latter contains the brain's limbic network. In both cases a successful and complete erection requires an intact neural system. Stimulation of the penile shaft by the nervous system contributes to nitric oxide (NO) secretion, which induces relaxation of the smooth muscles of the corpora cavernosa (the penis' main erectile tissue), and consequently penile erection.

Furthermore, the maintenance of a healthy erectile system requires sufficient amounts of testosterone (producted by the testes) and an intact pituitary gland. Impotence can develop due to hormonal dysfunction, neural system disorders, lack of sufficient supply of penile blood or psychological issues, as can be seen from the mechanisms of a normal erection. Injury to the spinal cord causes sexual dysfunction, including an ED. Blood flow obstruction may result from impaired endothelial function due to the normal causes of coronary artery disease, but can also be caused by excessive exposure to bright light.

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