Mario is a 68-year-old male whose wife died of cancer 5 years ago. Since her death, he began to eat ...

Mario's age is a major etiological factor for erectile dysfunction. It would also appear in his history that he has a lowered self-esteem; he had taken less care of himself since his wife died and was concerned about his sexual performance with his new girlfriend. Poor dietary choices and increased time spent in front of the television are further predisposing factors for ED.

Mario would likely be presenting with primary hypogonadism (hypergonadotropic hypogonadism). When testosterone levels decline, the testes become smaller and softer. The prostate enlarges and prostatic contractions weaken. While the seminiferous tubules thicken, the seminal vesicles become thin and less contractile as muscle is replaced by connective tissue. In the penis, there are fibrotic changes in the erectile tissues and vascular sclerosis. Because seminal fluid production also declines, the force of ejaculation is weakened.

The parasympathetic nervous system is responsible for erection. Parasympathetic activity inhibits the sympathetic nervous system's effect on promoting detumescence. It also encourages nitric oxide release to relax the smooth muscle of the sinusoidal spaces in the corpus cavernosum, enabling erection to occur.
Sympathetic activity is responsible for emission and ejaculation. Emission involves the process of sperm moving from the epididymis to the urethra and requires smooth muscle contraction in the vas deferens and ampulla. Sympathetic impulses also ensure muscular contractions of the seminal vesicles and prostate gland to propel seminal fluid along the urethra. The ischiocavernous and bulbocavernous muscles, under sympathetic influence, aid in the final propulsion of seminal fluid out of the penis.