Erectile Failure in Systemic Sclerosis

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Abstract
Krane et al. (Dec. 14 issue)1 have provided a comprehensive review of the pathophysiology, diagnosis, and treatment of impotence. Common causes of male erectile failure are categorized according to evolving concepts of pathophysiology. We would like to emphasize the association of impotence with systemic sclerosis (scleroderma), since this may be an early presenting symptom of this rheumatic disease. Impotence in association with systemic sclerosis was first described in 19812 and was attributed to microvascular abnormalities, neurogenic abnormalities, or both. In a recent review of systemic sclerosis,3 we noted the occurrence of erectile failure in 7 of 24 male patients (29 percent), and impotence was an important presenting symptom in 5 of these patients (21 percent). Male erectile failure in systemic sclerosis is probably "vasculogenic" and reflective of small-vessel disease.4 However, the recent descriptions of autonomic nervous system dysfunction in systemic sclerosis5 , 6 raise the possibility that abnormal parasympathetic innervation may contribute directly or indirectly to impotence in this setting.

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