Aging leads to atrophy and fibrosis of penile muscle, impairing erectile function.

“the problem is as we age we get atrophy of the muscle right and we get fibrosis of the muscle so as we get atrophy and fibrosis of the muscle we are able to get the blood in but we can't keep the blood in because we can't maintain enough pressure right on the Venus wall”

“so this phosphodis inhibitor which now we're into our third generation of them um basically solve the physiologic problem right so what is it the root of that problem I mean I understand that by inhibiting phosphod or esterase you keep around more cyclic GMP you maintain the flow of blood in the smooth muscle but what is it about the aging process and or its comorbidities that is leading to that venous leak in the first place right so that you nailed it to the main issue is Venous leak or we call a vinocclusive dysfunction”

“the main issue is Venous leak or we call a vinocclusive dysfunction so you have to think of the anatomy so it's actually very clever how the system was designed so if you think of the two tubes I was talking about earlier inside those two tubes are muscle and sinusoids down the center of the tube is an artery okay and think of the wall of the tube as a thick casing called the Tunica albuginea okay right under the Tunica albuginea are veins we call subtunical veins so as the blood comes in it presses against the wall and prevents the blood from coming out so very clever system the more blood comes in the muscle can press against the wall and prevent the blood from coming out of the penile tissue the problem is as we age we get atrophy of the muscle right and we get fibrosis of the muscle so as we get atrophy and fibrosis of the muscle we are able to get the blood in but we can't keep the blood in because we can't maintain enough pressure right on the Venus wall that's right”