Main Contents

Erectile Dysfunction (Impotence) and Diabetes.

Erectile dysfunction (ED) is a marker of potential cardiovascular disease, since it shares many risk factors with Erectile Dysfunction such as age, smoking or lipid abnormalities (high fat in the blood) and coexist with many other diseases, like diabetes and hypertension.

Erectile Dysfunction is a very common problem in men with diabetes and associated with diabetic neuropathy and peripheral vascular disease. 50% of men with diabetes develop this disease within 10 years of diagnosis. The prevalence is between 50% and 70% in men and diabetes increases with age, becoming 95% in diabetic men aged 70.

According to the MMAS study, the prevalence of impotence was 3 times higher for patients suffering from diabetes than patients not having it.

According to an epidemiological study with 15,770 diabetic patients, that have been diagnosed recently, 22% of patients already had Erectile Dysfunction. The prevalence for type I diabetes increased the risk from 6% for patients between 30 and 40 years old to 55% for patients between 60 to 70 years old. Likewise, for type 2 diabetes the risk increased from 4% to 48% for the same age groups.

In diabetics, erectile dysfunction can occur because of neuropathy (ex.: Polyneuritis), decreased blood flow (today we know that there are alterations in the endothelium, inner layer of blood vessels) and psychological factors.

In addition, when implanting a prosthesis to treat the Erectile Dysfunction, it has been found a loss of smooth muscle in the penis, more specifically in the cavernous tissue, in patients with diabetes.

We also know that levels of nitric oxide synthase, (enzyme responsible for transforming the L-arginine in nitric oxide, a gas vasodilator involved in one of the steps of both the erection of the penis and the clitoris, in the cavernous body) are decreased in diabetics, smokers and people with testosterone deficiency.

Diabetes is associated with loss of quality of life. According to a study published in the journal Diabetes Care, erectile dysfunction in diabetics is associated with an increase in stress caused by diabetes, worse metabolic control and very significant increase in depressive symptoms.

According to this study, 63% of patients reported that their doctors never diagnosed potential sexual problems, while the incidence increases a lot with the length and severity of diabetes.

The evaluation of patients with impotence is necessary to conduct a thorough medical history, considering surgery, endocrine disease, neurological, psychiatric or sexually transmitted infections (STIs).

We must look for evidence of cardiovascular disease and study the genitourinary system, and in particular seek signs of gynecomastia (enlarged breasts), pathology of the penis (like Peyronie) or testicles.

As for laboratory tests, an exhaustive exam has to be done to test for blood, testosterone, prolactin, TSH and prostate specific antigen (PSA). Other tests include penile Doppler, RigiScan, cavernosography and pelvic arteriography.

Several substances can induce erectile dysfunction: antihypertensives, antiarrhythmics, beta-blockers, antidepressants, antiandrogens (finasteride, now also used in alopecia, cyproterone), H2 blockers for ulcers (cimetidine, ranitidine), alcohol, illegal drugs and tobacco.

Treatments

Specific treatment of diabetes (oral medications, insulin, diet)
Treatment of other mayor risk factors: depression, hypertension, high cholesterol, smoking, sedentary life, alcoholism
Sildenafil (Viagra) and other inhibitors of phosphodiesterase like Cialis (tadalafil) and Levitra (vardenafil)
Apomorphine
Intracavernosal injection therapies (papaverine, phentolamine, PGE1)
B-complex vitamins (B1, B6, B12, folic)
L-arginine, Damiano, yohimbine (a laboratory is in Phase III of its research, and is testing a combination of yohimbine and L-Arginine to stimulate the production of nitric oxide synthase with very good results)
Testosterone and DUS (when they are low)
Increase physical activity
Sexual therapy