Neurogenic Factors The proportion of ED that is currently attributed to pathophysiology of the neurological system is likely underestimated. In the central nervous system, the amygdala, medial preoptic area (MPOA) and periventricular nucleus (PVN) of the hypothalamus, and the hippocampus are all involved libido and erection.
Parkinson’s Disease and Alzheimer’s Disease The prevalence of ED in men with Parkinson’s disease (PD) exceeds that of age-matched controls.
The pathophysiology of ED in patients with PD is multifactorial, as PD is characterized by significant psychiatric comorbidities and dysautonomia in addition to the destruction of dopaminergic cells in the substantia nigra.
The specific pathophysiology of ED in Alzheimer’s disease has not been elucidated but appears to be independent of concomitant risk factors such as age. Multiple Sclerosis One case-controlled study found ED to occur five times more often in men with Multiple Sclerosis (MS) compared to those with other chronic diseases. Over 50% of men with MS report either one or more of altered genital sensation, decreased libido, decreased intensity of orgasm, and increased time for arousal. Epilepsy Epileptic men also have an increased prevalence, with 15–57% experiencing ED.
Temporal lobe epilepsy, specifically, may exert its effects on erectile function through a derangement in the hypothalamic–pituitary axis (HPA). More pronounced in times of epileptic discharge, this derangement results in hypogonadotropic hypogonadism and hyperprolactinemia.