NEUROGENIC IMPOTENCE - CAUSES, ELECTROPHY SIOLOGIC INVESTIGATIONS, THERAPY

Erection is mainly, but not exclusively regulated by the parasympathet ic nervous system. Emission and ejaculation are controlled by the symp athetic nervous system. Somatic reflexes complete the neural pathways. Until now validated specific neurophysiologic examinations of the aut onomic innervation of the genital organs do not exist. Most of the neu rophysiologic examinations test structures of the somatic sacral nervo us system. In patients complaining of impotence the first diagnostic s tep should be a thorough clinical examination and history taking. If t here are signs or symptoms of a neurological disease the common neurop hysiologic tests should be performed, if not it is not necessary to do neurophysiologic examinations. However, tests of the thin or not myel inated nerve fibers should be more sensitive in evaluating the cause o f neurogenic impotence. The sensitivity and specifity of these tests r emains to be further validated. At the moment the first therapeutic ap proach is the local injection of vasoactive substances.