Erectile dysfunction is an under-recognized, complication of diabetes. But it is also one of the most treatable diabetic complications. Knowledge of impotence is rapidly expanding, and effective new treatments are now available, including oral medications
Diabetes is the next pandemic of the 21st century. Projected numbers reveal that by 2025, there will be 333 million people affected worldwide. Diabetes occurs when the pancreas does not produce insulin, a hormone that regulates blood sugar, or when the body cannot effectively use the insulin. Uncontrolled diabetes leads to serious damage to the nerves and blood vessels.
Awareness of impotence as a complication of diabetes has increased in recent years. Studies suggest that the risk is 50 percent higher for men with any type of diabetes, versus the general male population. Another worrying fact is that the onset of erectile dysfunction (ED) occurs 10–15 years, earlier in men with diabetes than in men without diabetes.
The Biology of the Problem
A man is considered to have ED if he cannot sustain an erection of sufficient rigidity for sexual intercourse. The proper sexual function requires the interaction of neurological, vascular, hormonal, and psychological systems. Normal erections require blood flow, but a significant role is played by nitric oxide. High levels of the chemical act as neurotransmitters that maximizes blood flow and penile engorgement. When nitric oxide-induced vasodilation ceases, so does the ability to have an erection. The inability to acquire an erection is directly correlated with low levels of nitric oxide.
The natural history of ED in people with diabetes is normally gradual and does not occur overnight. In people with diabetes, neurological and vascular systems are compromised. Blood flow in the penile arteries is limited by atherosclerosis. This loss of flow results in the inability of the corpora cavernosae (erectile tissue) to expand and compress the outflow vessels.
A major contributor to the high incidence of ED in people with diabetes is autonomic neuropathy is. In people with diabetes, the norepinephrine and acetylcholine positive fibers in the corpus cavernosum are reduced. This results in loss of the autonomic nerve–mediated muscle relaxation that is essential for erections.
Treatments Improve Sexual Health
Routine laboratory tests cannot identify the obvious causes of ED. Initial testing should be done for HbA1c, free testosterone, thyroid function. Preventive measures will reduce the risk of developing ED. Treatments include improving hypertension, glycemic control, reducing alcohol intake, ceasing cigarette smoking. The mention lifestyle changes have been shown to benefit patients. But in many cases, there is a need for medication or intervention of another kind.
- Viagra acts by blocking the catabolism of cGMP, increasing nitric oxide. Fifty-six percent of diabetic men with ED experience improvement with Viagra, compared to 70% of nondiabetic men with ED.
- Testosterone deficiency is a rare cause of impotence but should always be ruled out with a serum value. Studies have shown that a quarter of men with diabetes have low testosterone levels. Because testosterone has a large impact on sexual function in men, low testosterone can lead to ED. Testosterone replacement therapy should be administered to patients with documented low testosterone levels.
- Caverject is directly injected into the penis. It works more than 70% of the time. Most men shy away from needles and prefer oral medication before going the route of injections. Caverject works right away, it does not require you to be sexually stimulated to cause an erection.
- Exercising is important for men with diabetes or obesity, as it can lower blood glucose levels. Improvements in blood circulation can also help with ED. Clinical studies revile that weight loss helps in restoring sexual function.
- Mechanical therapy is also effective and is especially well-accepted in men. Vacuum-assisted erection devices are effective in creating erections in as much as 67% of cases. Vacuum pressure encourages increased arterial inflow, and occlusive tension rings discourage venous outflow. The penis is placed inside the cylinder. The pump produces a vacuum that pulls blood into the penis. Onto the base of the penis, the tension ring is slipped on and the cylinder is removed. Until the rings are removed the erection lasts.
- Psychotherapy should be offered to the patients and their partners. ED is not just a problem for man is a problem for couples, because it creates interpersonal conflict. Diabetes can lead to problems, such as depression or anxiety, which can worsen ED through psychological stress. Multiple strategies can be used to overcoming stress, such as meditation or counseling.
The Boston University Medical Center reports that 50% of patients with diabetes will develop erectile problems. However, people with diabetes adopt a healthier lifestyle, that may reduce diabetes symptoms, and improve sexual health. Knowledge is rapidly expanding, and effective new treatments are available. Physicians and patients must be aware of the causes and treatments of ED.