ERECTILE DYSFUNCTION IN MULTIPLE-SCLEROSIS - ASSOCIATED NEUROLOGICAL AND NEUROPHYSIOLOGICAL DEFICITS, AND TREATMENT OF THE CONDITION

Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated Emphasis was placed on the neurological features and the rel ationship between impotence and the bladder dysfunction in multiple sc lerosis. Erectile failure was invariably associated with pyramidal sig ns in the lower limbs and with urinary symptoms. All of the men with i mpotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoke d potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However recording the pudendal cortical response s in patients with multiple sclerosis and impotence provided no more i nformation than the tibial cortical evoked potentials. The neurologica l examination findings together with the results of the neurophysiolog ical and cystometric tests suggest that erectile dysfunction in multip le sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy f or men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the major ity of the impotent men. Erectile failure in patients with multiple sc lerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.