Sexual Dysfunction in Diabetes: Underrecognized and Neglected

Results of observational studies of pooled analyses in obese hypogonadal men with type 2 diabetes. Validity of the Arabic version of the sexual health inventory for men among Egyptians. Methods of alternative medicine are safest when used under the guidance of a doctor and in conjunction with other treatments.

Diagnosis of autonomic neuropathy was made clinically using the modified Ewing criteria after cardiovascular autonomic function tests involving three heart rate (HR) tests with simultaneous electrocardiographic recording and two BP tests [12]. However, its risk factors have not been well studied. They form covalent bonds with vascular collagen, an interaction that increases vascular permeability, procoagulant expression, reactive oxygen species and endothelial expression of adhesion molecules [45Wen Y. This hand- or battery-powered device is simple to operate and has a low risk of problems. Men with diabetes and ED who do not respond to PDE5 inhibitors should be investigated for hypogonadism with measurement of a morning serum total testosterone level drawn before 11 am [Grade D, Level 4 (19,40,41,43)]. 5% had low testosterone concentration, <8 nmol/L.

4), while subjects with ABI >1.

Selvin E, Burnett AL, Platz EA. If you're a diabetic man who has a problem with erectile dysfunction, don't suffer in silence. Read “Sexual Wellness” and “When Diabetes Affects Your Sex Life.

Sexual function in men with diabetes type 2: 69), and severe obstruction (<0. They have been shown to have major impacts on erectile function and quality of life, with a low reported side effect profile, and should be offered as first-line therapy to men with diabetes wishing treatment for erectile dysfunction.

Diabetic retinopathy affects most patients who have long-standing diabetes [49Morello C.

Popular in: Erectile Dysfunction/Premature Ejaculation

You must use the correct-size tension ring and remove it, to prevent penile bruising, after sustaining the erection for 30 minutes. This device, also called a penis pump or a vacuum pump, is a hollow tube you put over your penis. Common conditions, administration of the first injections of CaverJect should be done in the physician's office by medically trained personnel. The scores range from 0 to 25. It suggests that an assessment of erectile dysfunction could be useful when assessing the risk of heart disease in men with diabetes. These divergent prevalence rates may be accounted for by differences in the populations studied including but not limited to population sizes, demographic characteristics, duration and severity of diabetes, and presence of other confounding comorbidities.

Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs.

Which treatment is the best for diabetes and ED?

Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: Whether this influenced the finding in our study remains to be elucidated. However, only 15% of this cohort had diabetes (110). This is a natural part of the aging process. 01), occupation status (p-value = 0. Atherosclerosis makes it difficult for blood to enter the penis. You can still get aroused, but you'll have trouble turning those feelings into action.

Although, cardiovascular diseases, chronic kidney failure, retinopathy and peripheral neuropathy have been widely investigated, physicians also recognize that there are sexual problems prevalent in diabetic men and women. 5 mmol/L, low density lipoprotein >2. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. Crossref | PubMed | Scopus (8) | Google ScholarSee all References, 90x90Saboor Aftab, S. 001 Autonomic neuropathy, (%) 12 (27. )What causes erectile dysfunction amongst diabetics?

  • These therapies were rarely efficacious.
  • 01), type of treatment of diabetes ( p -value = 0.
  • Large epidemiological studies have also confirmed the strong association between ED and future cardiovascular events [26Thompson I.
  • Why do men with Diabetes have Erectile Dysfunction?
  • Tell your doctor what’s going on.
  • In fact, some hardly miss their erections.


Men with diabetes are three times more likely to report having problems with sex than non-diabetic men. Erectile dysfunction is a common occurrence in men with diabetes. Discuss pelvic floor physical therapy with a doctor to learn which exercises are most effective. The hospital’s Research and Ethics Committee approved the research protocol. Hypnosis scripts, drugs can not cure or get access to the root of the problem. Moreover, the development of ED has been shown to worsen any pre-existing depressive symptoms, which suggests the possibility of a reinforcing mechanism [24De Berardis G.

Low Testosterone

If this is you, and you’re experiencing problems with your sex life, there’s a good chance you’re feeling anxious, frustrated and depressed. A man needs to try the medicine at least four times before he concludes that it doesn’t work for him. Subscribe to Streaming Well: 25–26 Vascular reconstructive surgeries are beneficial in certain groups. When erection is no longer desired, a valve on the pump is pressed, and the penis becomes flaccid. Click here to see the Library, 96Sesti C. As a guy, you’re more likely to get type 2 diabetes at a lower weight than women.

Most people with diabetes will be on multiple drugs with the potential to cause this condition. Treatment strategies in ed and novel perspectives, however, as above, it is possible that one medicine will be more or less effective than the others, and therefore it is best to initially try out all three to see which is best. This is because research indicates that sexual dysfunction can occur in those with diabetes years earlier than it affects those in the general population, he stressed. Selective nitrergic neurodegeneration in diabetes mellitus – a nitric oxide-dependent phenomenon Br J Pharmacol 1999 ; 128 : Despite the aforementioned clinical importance of ED in diabetic men, studies have shown that most clinicians do not enquire about sexual dysfunction during consultations and the prevalence of self-reported ED is very low [9]. The major culprits are thiazide diuretics, beta-blockers, and centrally acting drugs such as alpha-methyldopa. What comes after an ED diagnosis in diabetic patients? These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation.

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If pelvic nerves that trigger penis muscles to relax are impaired, there may be a break in the chain between brain and penis, disrupting erection. “All the tiny little arteries that feed blood to the muscle get occluded. Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance [1]. Click here to see the Library], dilate the epicardial coronary artery and inhibit platelet activation [98Halcox J. J Sex Med 2020;6(5): 001 HbA1c (%) <0. Others prefer to start with the highest dose and go to a lower dose only if a man complains of side effects.

Crossref | PubMed | Scopus (0) | Google ScholarSee all References, 104x104Haider, A.

Partial occlusion of the pelvic or intracavernosal arteries, hypogonadotropic hypogonadism, and depression associated with a chronic illness (DM) can all play a primary or secondary role in the development of EDDM.

Don’t Ignore Erectile Dysfuntion: It’s Treatable!

Some studies have also shown that increasing physical activity and losing weight may be of benefit to sexual function [71Adeniyi A. Those men were also more likely to have ED, though the link may have to do with weight, not diabetes per se. ED is common in diabetes patients, but the pathogenesis of diabetic ED is multifactorial and complex. Here are some other points to keep in mind: These lifestyle habits include eating a balanced diet and getting regular exercise. Semi-rigid or malleable rods are the simplest and least expensive of all. Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score?

6 mmol/L, triglycerides >1.

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Recently, 2 new PDE-5 inhibitors, vardenafil and tadalafil, were introduced. A phenomena common amongst most men at some point of their life, the causes are numerous and varying. Nicolosi A, Moreira ED, Shirai M, Tambi MIBM, Glasser DB. Due to the natural variability of serum testosterone levels, repeat testing is often helpful to clarify the diagnosis. Diabetics and patients with hypertension frequently have heart disease. A longitudinal study by De Berardis et al.

Erectile dysfunction can stem from problems caused by poor long-term blood sugar control, which damages nerves and blood vessels. Several antihypertensive medications have been linked to ED in the general population. Erectile dysfunction in type 2 diabetic men: Men with diabetes having trouble with achieving and/or maintaining an erection can take oral medications like sildenafil (Revatio, Viagra), tadalafil (Adcirca,Cialis), avanafil (Stendra), or vardenafil (Levitra, Staxyn). Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows).

Predictors for erectile dysfunction among diabetics. Sex brings a range of physical and psychological benefits, whether you have diabetes or not. Studies suggest that 35-75 percent of men with diabetes will go on to develop ED. Fareed M, Salam N, Khoja AT, Abdulrahman M. This was a cross-sectional study of 160 male type 2 DM adults, aged 30–70 years, attending a tertiary healthcare clinic.

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On the other hand, if some men didn’t report their erectile dysfunction and experienced cardiac events, the study will have underestimated the strength of the association. Click here to see the Library] reported the strong predictive value of depressive symptoms in the incidence of ED among diabetic men. For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

In some cases, a man may experience drug side effects severe enough to outweigh any potential benefit of taking the drug.

Strengthening these muscles may also improve erectile function. Oral medicines: Abstract | Full Text | Full Text PDF | PubMed | Scopus (85) | Google ScholarSee all References, 102x102Taylor, S. Share on Pinterest The right treatment can reduce or eliminate ED symptoms. Although cigarette smoking is a well recognized risk factor for ED in diabetics possibly through the acceleration of atherosclerosis which is the main pathogenic pathway for vasculogenic ED [17], this was not the case in our study. As a result, many diabetic men become impotent and develop serious frustration.

152 (95%) patients with a mean age of 60.

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The physiological changes associated with fear can themselves cause ED! During the course of approximately 4 years, the incidence of CAD was greater in men with ED (19. )Impotence and its medical and psychosocial correlates: BJU Int 2020;99(1): Subjects who had ED were significantly older than control subjects (mean age of years versus years; ). In addition, ED appears to arise about 10 years earlier in diabetic patients than in the general population [2Feldman H. The EDDM patient had one option, implantation of a penile prosthesis. No matter what the cause of erectile dysfunction, it is likely to cause feelings of stress and other emotional reactions.

Links To The Science

A band placed at the base of the penis maintains the erection after the tube is removed. Nerve damage may also play a role. Presence of autonomic neuropathy was associated with a threefold increase in the risk of ED on multivariate analysis. It’s also not uncommon for erection problems to cause tension in a relationship, particularly if one or both partners withdraws emotionally and the problem is not talked about.

  • And it's a complicated problem, too, with diverse physical origins and complex emotional ramifications.
  • Gazzaruso C, Giordanetti S, De Amici E, et al.
  • (37), and testosterone deficiency, 6.
  • The sooner ED is diagnosed and treated, the better.
  • Impotence is a broader term.
  • A vacuum erection device helps draw blood into the penis by applying negative pressure.

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You can avoid getting a UTI by keeping your blood sugar as close to your target as you can. Whatever you need, you're not alone. Specialists such as urologists can work with individual cases and determine the best treatment.

Giannetta E, Feola T, Gianfrilli D, et al. 6 Endothelial dysfunction is a condition in which the endothelium (inner lining) of blood vessels fails to function normally. Click here to see the Library], reduce ischaemic cell death [96Sesti C. Above the age of 50, the likelihood of having difficulty with an erection occurs in approximately 50% to 60% of men with diabetes. Difficulty maintaining an erection might even precede the diabetes diagnosis. 8 Cigarette smoking (pack-years) 1. At this pressure the penis has sufficient axial rigidity to permit vaginal penetration. It does however emphasise the importance of assessing whether a lack of diabetic control is leading to erectile dysfunction.

A decrease in testosterone production has also been identified as the cause in some men with diabetes. “If a patient has diabetes and is newly diagnosed, a significant portion of these men are going to develop coronary artery disease in the next 2-3 years,” he said. 7 A transdermal testosterone gel or patch, or intramuscular testosterone cypionate are the alternatives.

Low Testosterone

If you are a current subscriber with Society Membership or an Account Number, claim your access now. (7%) had ED at baseline, as defined by the 1992 National Institutes of Health Consensus Conference [1NIH Consensus Development Panel on Impotence. 16 aimed to test the hypothesis that ED improves CVD prediction beyond traditional risk factors. Talk to someone, you and your healthcare professional can decide the best way to treat your depression during pregnancy. Diabetic men with erectile dysfunction might consider a prescription for a drug like Viagra to be a permanent cure for a temporary issue: Moreover, testosterone therapy in hypogonadal men has been shown to improve both libido and sexual performance [33]. If the cause is psychological, your doctor may refer you to a psychiatrist, psychologist, sex therapist, or marital counselor. In this way, they could see if there was an association between heart problems and erectile dysfunction in men with diabetes.

Diabetes is far from the only cause of erectile dysfunction, so it’s nothing to be embarrassed about. But that means you won’t get to hear the good news either. ED patients may be physically examined, and bodily features can give clues to the cause. Recent research, however, suggests that addressing low testosterone levels with TRT in the context of ED is associated with multiple small health benefits that may be equated to considerable benefit to patients. As stated previously, low levels of nitric oxide are often found in men with diabetes. The commonest clinical presentation of PAD is lower limb claudication [21]. 14, 95% CI = 1. In some particular cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in men and is relatively easily curable.

The sinusoids open and rapidly fill with blood. Erectile function was assessed using an abridged version of the International Index of Erectile Function (IIEF-5). This could mean you have difficulty getting aroused, both physically and in how you feel. Lastly, reduce bad cholesterol (low density lipoprotein) to less than 100 mg/dL. Surgery for erectile dysfunction is usually considered only after all other options have failed.


Erectile dysfunction and coronary atherothrombosis in diabetic patients: Parts are inserted surgically into the penis and scrotum, and activated by squeezing. Multiple logistic-regression analyses showed that ED, apolipoprotein (a) polymorphism, smoking, microalbuminuria, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were all significantly associated with silent CAD; among these risk factors, ED appeared to be the most effective predictor of silent CAD [odds ratio (OR): In this cohort of 2306 patients with a median follow-up period of 4 years, 616 (26. )Cialis is currently the preferred drug since it is the only one that may be taken on a full stomach and lasts for 36 hours. ED is established as an independent marker for the development of coronary artery disease (CAD) occurring on average 3-5 years before the onset of CAD. Observational data from two registry studies.

Testosterone deficiency, cardiac health, and older men. Superoxide radicals are present in larger amounts in cavernosal tissue, whereas levels of NO synthase are reduced in men with diabetes-induced ED. Central obesity was present in 50. Jackson et al. Just like complications of the heart, eyes, kidneys and nerves are related to blood vessel damage, so is diabetes-related sexual dysfunction.

Nih consensus development panel on impotence. Pink guy, but when it happens to you, Dr. This is believed to be a result of altered vasomotor tone or other factors (78). 3 were classified as “poorly compressible” and excluded from the analysis. An erection starts in the brain. Ask if any medicine you’re taking — including antidepressants or blood pressure medication — could be worsening your erectile problems. If you are considering one of these drugs and you have heart disease, as many diabetics do, be sure to tell your doctor. GoodRx is not available outside of the United States. This suggests that older age may be acting indirectly through other risk factors for the development of ED in the diabetic subjects and this underscores the importance of controlling these other risk factors since aging is not modifiable.

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Retinopathy is related to the angiographically detected severity and extent of coronary artery disease in patients with type 2 diabetes mellitus Int Heart J 2020 ; 46 : The effect of sildenafil on human vascular function, platelet activation, and myocardial ischemia J Am Coll Cardiol 2020 ; 40 : McCulloch D, Campbell I, Wu F, Prescott R, Clarke B.

  • The cylinder is placed over the flaccid penis and held tight against the pelvis.
  • Erectile dysfunction due to diabetes is much better understood now.

What Were The Results Of The Study?

20, 24 followed by injections of drugs into the penis, as well as penile implants. The connection between diabetes and ED is related to your circulation and nervous system. Fifty to 70 percent of men with type 1 or type 2 diabetes respond to a class of drugs—including sildenafil (Viagra), var­denafil hydrochloride (Levitra), and tadalafil (Cialis)—called phosphodiesterase-5 inhibitors. The causes of erectile dysfunction in men with diabetes are complex and involve impairments in nerve, blood vessel, and muscle function. The combination of an increased inflow of blood into the penis and coincident markedly diminished outflow results in rapidly increasing intracavernosal pressure that ultimately approximates systolic pressure. 26 Some sources show that vascular reconstructive surgeries are viable options for some people.

“Erection is a hydraulic phenomenon that occurs involuntarily,” says Arturo Rolla, MD, of Harvard University School of Medicine. Diagnostic workup of hypogonadism (TDS) (modified from reference [91]). 14 Data are in means (standard deviations) or numbers (percentages).

Trends and future projections of the prevalence of adult obesity in Saudi Arabia, 1992-2022.

Key Messages Regarding Hypogonadism in Men with Diabetes

The doctor can then make sure the dysfunction isn't a symptom of some other hidden disease. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram. It has been demonstrated to negatively impact quality of life among those affected across all age strata and may be an early clinical indication of cardiovascular disease. 6 Total 152 100. Yohimbine, an alpha-adrenergic receptor antagonist, is recommended in a dose of 5–10mg three times a day.

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9 OHA + Insulin 21 13. To understand what happens in ED, it's helpful to know some anatomical basics. Sildenafil for treatment of erectile dysfunction in men with diabetes: Currently using the pump which works but it is a little cumbersome. Recent studies have reported that alteration of the cyclic guanosine monophosphate (cGMP)/nitric oxide (NO) pathway among men with diabetes with impaired vascular relaxation is related to endothelial dysfunction (16–18). Rosen RC, Wing RR, Schneider S, et al. Click here to see the Library, 81Rendell M.