Neural regulation of sexual function in men.
Neural regulation of sexual function in men.
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DOI：
10.5410/wjcu.v2.i3.32
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发表时间：
2013-11-24
期刊：
影响因子：
--
通讯作者：
Siroky, Mike B
中科院分区：
文献类型：
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作者：
Azadzoi, Kazem M;Yang, Jinghua;Siroky, Mike B
男性的性反应是由一系列神经介导的现象控制的，包括性欲、动机、性唤起和生殖器反应，如阴茎勃起和射精。这些神经事件发生在激素定义的环境中，涉及由中枢机制、脊髓反射和周围神经系统控制的不同神经生理、神经化学和神经心理参数。流行病学研究表明，男性性功能障碍在世界范围内的高患病率对患者的生活质量产生了重大影响。在患有神经系统疾病的男性中，性功能障碍的发生率尤其高。男性性功能障碍，如性欲丧失、勃起功能障碍（ED）、性兴奋改变、性高潮和射精障碍可能涉及器质性原因、心理问题，或两者兼而有之。器质性男性性功能障碍包括各种各样的神经、血管、神经血管或激素因素，这些因素会干扰性欲、勃起、射精和性高潮。神经性性功能障碍可能是由特定的神经系统问题引起的，也可能是发展中的神经系统疾病的表现症状。神经性ED可由慢性神经系统疾病、创伤、手术损伤或医源性原因引起的并发症引起。这些病因因素和潜在的病理生理条件可能重叠，在进行诊断和选择治疗时应考虑到这一点。详细的体格检查史，神经系统疾病史，以及任何过去的心理和精神障碍史，以及彻底的神经系统检查将有助于更好地了解神经源性性功能障碍的潜在原因。在脊髓损伤患者中，应确定病变的位置和损伤发生的时间。针对勃起功能障碍的治疗策略是使用磷酸二酯酶抑制剂进行侵入性最小的选择。当口服药物的选择是用尽，经尿道和海绵体内治疗和最终真空收缩装置和阴茎植入考虑。最近的基础研究表明，在实验模型中，基于干细胞的治疗策略在保护阴茎神经完整性和逆转海绵体神经变性方面具有潜在的作用。进一步了解男性性反应的中枢、脊柱和周围神经机制可能有助于准确诊断和更好地管理男性神经源性性功能障碍。
Male sexual response is controlled by a series of neurally mediated phenomena regulating libido, motivation, arousal and genital responses such as penile erection and ejaculation. These neural events that occur in a hormonally defined milieu involve different neurophysiological, neurochemical, and neuropsychological parameters controlled by central mechanisms, spinal reflexes and peripheral nervous system. Epidemiologic studies have suggested the high prevalence of male sexual dysfunction worldwide with significant impact on the quality of life of patients suffering from this problem. The incidence of sexual dysfunction is particularly high among men with neurologic disorders. Sexual dysfunction in men, such as loss of sexual desire, erectile dysfunction (ED), changes in arousal, and disturbances in orgasm and ejaculation may involve organic causes, psychological problems, or both. Organic male sexual disorders include a wide variety of neurologic, vasculogenic, neurovascular or hormonal factors that interfere with libido, erection, ejaculation and orgasm. Neurogenic sexual dysfunction may result from a specific neurologic problem or it could be the presenting symptom of a developing neurologic disease. Neurologic ED could result from complications of chronic neurologic disorders, trauma, surgical injury or iatrogenic causes. These etiologic factors and the underlying pathophysiologic conditions could overlap, which should be considered when making a diagnosis and selecting a treatment. A detailed history of physical examination, neurologic disorders, as well as any past history of psychological and psychiatric disturbances, and a thorough neurological examination will provide better understanding of the underlying causes of neurogenic sexual dysfunction. In patients with spinal cord injury, the location of the lesion and the time of onset of injury should be determined. Therapeutic strategies against erectile dysfunction are initiated with the least invasive options using the phosphodiesterase inhibitors. When oral medication options are exhausted, intraurethral and intracavernosal therapies and ultimately vacuum constriction devices and penile implants are considered. Recent basic research has suggested the potential role of stem cell-based therapeutic strategies to protect penile neural integrity and reverse cavernosal neurodegeneration in experimental models. Further insight into the central, spinal and peripheral neural mechanisms of male sexual response may help precise diagnosis and better management of neurogenic sexual dysfunction in men.