Relationship between erectile dysfunction and vitamin D

Human sexual activity is the manner in which humans experience and express their sexuality. Male penile erection is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged in response to sexual arousal during sexual activity. 

Penile erection is the result of a complex interaction of psychological, neural, vascular, and endocrine factors in the presence of a normal penis anatomy. 

Penile erection is initiated by nitric oxide (NO), a potent vasodilator, released from the nerve endings, further production of NO depends on increased blood flow which is also known as shear stress.

In most vascular beds, the NO is released by a stimulus that increases the shear stress over the endothelium. Endothelial dysfunction is a key variable in the pathogenesis of atherosclerosis and its complications, including erectile dysfunction (ED).

ED is defined as the inability to attain or maintain erection sufficient for satisfactory sexual activity. 

Over the past 20 years, there have been numerous reports on the epidemiology of ED all over the world. 

In all studies, it was demonstrated that he prevalence of ED increases with age. 

In other words, higher age is strongly associated with higher incidence of ED. In men under the aged 40 to 49 years, the prevalence of ED was relatively low (~40%) and in men aged 70 to 79 years, the prevalence of ED was significantly higher (~90%). 

The etiology of ED has been studied comprehensively and found to be multifactorial. ED is frequently found in vascular syndromes, such as atherosclerotic cardiovascular (ASCV) diseases, hypertension, cerebrovascular disease, peripheral arterial disease and diabetes mellitus (DM). 

In fact, the penis is a highly vascularized organ and erections are primarily vascular events. Both ED and ASCV diseases have frequently identical functional and morphologic basis. 

Because of its vascularity, ED is even accepted as a marker of coronary endothelial dysfunction and atherosclerosis.

Vitamin-D and androgen receptors

An extra mechanism of VD on erectile function seems to function via binding to T receptors. Computer (in silico) modeling shows that besides activating the VDR, 1,25-D displays high affinity for some of the body's other nuclear receptors. 

This suggests that when 1,25-D increases above its normal range, it binds the ?/? thyroid, the glucocorticoid, and the T receptors, displacing their native ligands. Marshall showed the symmetry with which endogenous ligands exhibited very similar affinities across some members of the type 1 nuclear receptor family. 

For example, 1,25-D docked into the VDR with a (nanomolar) Kd of 8.48, but also exhibited a Kd of 8.05 into the T receptor.

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