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Erectile Dysfunction (ED)

Sensory neuropathies

01/05/2007

Question:

Is it possible that sensory neuropathies, such as Charcot-Marie-Tooth disease could cause impotence? There are decreased deep tendon reflexes.

Answer:

While research is limited, it appears that sensory neuropathy may be linked to ED Here are 3 references:

1. Bird TD, Lipe HP, Crabtree LD. Impotence associated with the Charcot-Marie-Tooth syndrome. Eur Neurol. 1994;34(3):155-7.

Department of Medicine (Neurology and Medical Genetics), University of Washington, Seattle.

We report 7 men (ages 45-61 years) with impotence associated with the Charcot-Marie-Tooth syndrome (CMT). The range of onset of erectile dysfunction varied from 38 to 55 years of age. One patient had classic CMT 1A with autosomal dominant inheritance, slow motor nerve conduction velocities and the 17p DNA duplication. One had probable type-II hereditary motor and sensory neuropathy. None of the patients had diabetes. There was some benefit from papaverine injection therapy or penile implants. The association of impotence with CMT is likely to be more common than previously recognized. PMID: 8033941 [PubMed - indexed for MEDLINE]

2. Wellmer A, Sharief MK, Knowles CH, Misra VP, Kopelman P, Ralph D, Anand P.

Quantitative sensory and autonomic testing in male diabetic patients with erectile dysfunction. BJU Int. 1999 Jan;83(1):66-70.Department of Neurology, St. Bartholomew's and the Royal London School of Medicine, London, UK.

OBJECTIVE: To correlate abnormalities of nerve fibres in the lower limbs with erectile dysfunction in male diabetic patients, using a range of quantitative sensory and autonomic function tests.

CONCLUSIONS: There appeared to be preferential involvement of unmyelinated sensory fibres that mediate axon-reflex vasodilatation in the limbs of diabetic patients with erectile dysfunction. This test appears to be a helpful indicator of neurological involvement in erectile dysfunction, and may be used to monitor the effect of new treatments. PMID: 10233454 [PubMed - indexed for MEDLINE]

3. Bleustein CB, Arezzo JC, Eckholdt H, Melman A. The neuropathy of erectile dysfunction. Int J Impot Res. 2002 Dec;14(6):433-9.

Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA. cbluestein@aol.com

These studies were intended to explore the relationship between autonomic neuropathy and erectile dysfunction (ED). Sensory thresholds reflecting the integrity of both large diameter, myelinated neurons (ie pressure, touch, vibration) and small diameter axons (ie hot and cold thermal sensation) were determined on the penis and finger. Data were compared across subjects with and without ED, controlling for age, hypertension and diabetes.

The findings demonstrate dysfunction of large and small diameter nerve fibers in patients with ED of all etiologies. Further, the neurophysiologic measures validate the use of the IIEF as an index of ED, as objective findings of sensory neuropathy were highly correlated with worse IIEF scores. The sensory threshold methods utilized represent novel, non-invasive and relatively simple procedures, which can be used in a longitudinal fashion to assess a patient's neurologicalresponse to therapies. PMID: 12494274 [PubMed - indexed for MEDLINE]

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Response by:

Allen D Seftel, MD Allen D Seftel, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University