Central control of erection and its pharmacological modification

Advances in our understanding of the local mechanisms of penile erection have paralleled the use of pharmacological treatments of erectile dysfunction. In contrast, the spinal and supraspinal mechanisms that control penile erection are less well understood. Although the role of hypothalamic areas (medial preoptic area, paraventricular nucleus) and brainstem nuclei (raphe nuclei) in penile erection has been evaluated, as has the role of an association between neuromediators and receptors (serotonin, dopamine, noradrenalin, glutamate, gamma-aminobutyric acid, nitric oxide), an integrative view of the central mechanisms of penile erection is lacking. New strategies to treat erectile dysfunction employ oral agents, some of which target central brain nuclei. The future of such treatments largely depends on a better understanding of the central mechanisms of penile erection.