Erectile dysfunction (ED) is a major diabetes complication yet it gets little attention
It is a touchy subject for some man and that is one reason for the neglect. I found three studies approaching ED in different angles.The first “Erectile Dysfunction in the patient With Diabetes Mellitus” a broad view of ED and diabetes; the second “Impact of Diabetes Mellitus on the Severity of erectile dysfunction and response to treatment” discusses effectiveness of treatment with Cialis; the third study “Erectile Dysfunction and Quality of life in Type 2 Diabetic Patients” examines the impact ED on patients overall psychological health and life quality. I like to bring out the essence of these studies as it pertains on a daily basis living. The first study gives us a broad view on ED and diabetes.
ED is present in 32% of type I and 46% type II diabetes patients. Health care providers have long known about the impact and frequency of ED but still this area gets less attention then the glucose level management overall. A diagnosis of ED gives health care providers reasons to suspect diabetes. For 75 years of the 20th century there were very few resources diabetic man had in order to treat ED. Natural remedies such as Yohimbine and a combination of testosterone treatments or thyroid supplements were commonly used but with little results. ED patients had one option, implantation of penile prosthesis. With the use of Sildenafil citrate as an agent medications known as Cialis or Viagra began to change this scenario dramatically, as we should find out in the next paragraphs. The study goes on to explain how an erection takes place and how it is affected by diabetes.
The initial event for a normal erection is sexual stimulation. The nervous system being activated send impulses to the erectile bodies in the penis releasing nitric oxide. After a cascade of chemical reactions decreasing intracellular calcium and opening of potassium channels it produces a relaxation in the vascular smooth muscle of the penis. The sinusoids open up and the penis is filled with blood but because the sinusoids are compressed blood is trapped creating an increased inflow with an decreased outflow ultimately approximating systolic pressure. Listed below are diabetic associated problems which interferes with the erection natural process.
- Abnormalities in the vascular, neural, endocrine, muscular or psychiatric systems can result in ED
- Abnormal high amounts of glucose in the blood can affect potassium channels which facilitate penile muscle relaxation
- Decrease in smooth muscle and increase in collagen caused by an increase in growth factor-beta which is caused by insulin excess circulation in the blood
- Neuropathic damage to both the somatic and autonomic nerves
- Partial occlusion of the pelvic or intracavernosal arteries
- Depression associated with chronic illness
- Abnormalities in nitric oxide sensitivity
- Age and diabetes also aggravate these conditions
There are many first lines of defense one can use to address ED other then medication. First therapies should be aimed at reducing the conditions which aggravate ED. Smoke cessations, increase exercises tighter glycemic control and attention to dietary restrictions, and also moderation of alcohol use. The risk factors for cardiovascular disease are also risk factors for ED so this should be also addressed. There is very little evidence that the improving of these conditions will eliminate ED but they will certainly make things better for the health of the individual. The use of drugs to treat related diabetes conditions can also cause ED such as antihypertensive medications. Replacement of thiazides or beta-blockers with angiotensin-converting enzyme inhibitors may be sufficient to regain erectile ability. Careful monitoring the side effects of these medications will also determine if ED is caused by diabetes or by the use of the medications themselves. The best line of treatment however is Sildenafil citrate or tadalafil.
In our second reviewed study “Impact of Diabetes Mellitus on the Severity of erectile dysfunction and response to treatment “A large and well defined group of participants from 20 countries with ED and diabetes are compared to man that are diabetes free but also have ED. The study found that ED in man with diabetes is more severe than man without diabetes. The mean erectile dysfunction domain in patients with diabetes was 12.6 compared to 15. in the diabetic population. Patients treated with tadalafil had a 17% success rate compared to 24% of patients without diabetes. Tadalafil taking as needed prior to sexual activity was well tolerated and significantly improved erectile function in men with diabetes for up to 36 hours after dosing, despite the severity of erectile dysfunction in this population. The improvement was not affected by the level of baseline diabetic control or by the specific diabetic therapy received.
Our last study “Erectile Dysfunction and Quality of life in Type 2 Diabetic Patients” focuses on the impact in the quality of life for patients with diabetes and ED. The presence of a normal sexual desire and the inability to physically act on that desire can affect patients lives in different ways, including disorders in interpersonal relationships, interference with sexual life, problems with partners, and increase in mental stress making ED a major quality of life issue. Little is known about the true impact ED has in the diabetic population and only small sample data is available.
Subjects were enrolled by 114 diabetes outpatient clinics and 112 general practitioners. All subjects were asked to complete a questionnaire as they entered the study on a 6 month interval over a period of 3 years. There was a diabetes health distress and a sexual life questionnaire. The results revealed a close relationship between the presence of ED and a worse subjective perception of health status for all subjects assessed. Man with self-reported ED showed significantly higher levels of diabetes-specific health distress, worse psychological adaptation to diabetes and a less satisfactory sexual life. 45.6% of patients with frequent ED reported severe depressive symptoms. 50% of the patients with ED considered diabetes to have a great impact on their sexual life. As far as health care providers involvement in the treatment of ED only 10.1% of the patients reported that their doctors asked them about their sex lives or satisfaction with their sexual relations. This exposes how health care providers are not aware of this problem or don’t consider it to be or great importance.
In conclusion ED has a profound impact on several layers of psychological well-being. The strong association between sexual dysfunction and impaired quality of life justifies the acknowledgment that ED in diabetic patients is a significant public health problem and calls for a much greater attention to the identification of patients suffering from ED. To this regard, sexual function should be considered an integral part of overall health in diabetic patients.
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