Management of Diabetic Men with Erectile Dysfunction

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Dec 19, 2014/ 0 Comments / in Erectile Dysfunction / by
Management of Diabetic Men with Erectile Dysfunction

Management of Diabetic Men With Erectile Dysfunction

Men with long-standing diabetes are at risk of developing Erectile Dysfunction (ED), but it is imperative to understand that these complications can be avoided as well as managed with adequate precautions, treatment modifications and supplemental support.

ED can be defined as the inability to sustain an erection adequate enough to successfully complete the act of sexual intercourse. Based on the statistics reported by Thorve (1) and colleagues, the prevalence of ED in diabetic males is more than 50%. According to another study, published in The Journal of Sexual Medicine (2), the risk of ED can be as high as 90% in males who have 2 or more positive risk factors (discussed under the following section).


Pathophysiology of Erectile Dysfunction in Diabetic Males

Diabetes & ED

Clinical study indicates that abnormally high blood sugar levels can lead to vasculitis (inflammation of blood vessels) and Neuritis/ neuropathy (inflammation of nerves). In cases of severe involvement, this may presents with moderate to severe erectile dysfunction. There are a number of factors that may determine the severity of ED in the setting of diabetes mellitus; such as:

  • Age: In diabetic males under 24 years of age, the prevalence of ED is only 6%. However, in males over 50 years, more than 55% diabetic males report some degree of sexual dysfunction.
  • Other relevant risk factors include; history of hypertension or cardiovascular illness, advanced atherosclerosis, hypercholesterolemia and mental health issues (such as depression, anxiety, etc.)

Needless to say that poorly addressed erectile dysfunction may lead to deleterious effects on the relationships, mental health and physical wellbeing. However, experts suggest that timely measures can be taken to taper of these negative effects and regain vitality.


Manage Erectile Dysfunction in Diabetic Males

ED Diagnosis & ScreeningTake advice:

Talking about erectile difficulty and sexual dysfunction is understandably a very cumbersome issue for some males, but it is highly recommended to share your concerns and any recent changes in the quality of your sex life with your primary care provider. Seeking advice from a healthcare provider may help in a number of ways:

  • Patient Education: The risk of diabetic complications can be significantly reduced with patient education and training. Learning more about your disease status can help in devising functional strategies to obtain glycemic control. Optimal regulation of blood sugar levels can decrease the risk of nerve damage and may help in reversing ED.
  • Counseling regarding the cause of erectile dysfunction and treatment options: Healthcare providers also helps in ascertaining the cause of ED in your case and may offer relevant information regarding different treatment modalities.
  • Therapeutic and Pharmacological Options: In a number of cases, erectile dysfunction is due to side-effect of one or more pharmacological agents. For example, research reported in American Journal of Therapeutics (3) suggested that erectile dysfunction is strongly related to some hypoglycemic agents, insulin therapy, anti-hypertensive drugs, cholesterol lowering drugs and anti-psychotics. If you are experiencing sexual dysfunction, it is highly recommended to speak to your doctor regarding dose modification, drug adjustment or other alternative options.

Treatment Choices Available

Aging & ED

Ask your physician to prescribe you a suitable medicine from a very wide range of available medications.

Phosphodiesterase Inhibitors: There are the drugs that help in maintaining a sustained and uninterrupted blood supply to the penis; thereby maintaining a normal erection (4). Common names of these medicines are Sidlenafil (revatio or Viagra), Vardenafil (staxyn or levitra) or tadalafil (adcirca or cialis). Ask your physician about their safety and suitability in your case.

Oral testosterone is also helpful in certain cases where phosphodiesterase inhibitors fail (5)

Other medicines. If oral tablet is contraindicated in your case, then your doctor may prescribe a suppository to be placed in the cleft at the summit of the penis prior to intercourse or an injectable to be injected into the bottom of the penis. Both these medicines work the same way as oral medicines and potentiate blood perfusion to the penile tissue for a sustained erection.

Vacuum-constriction appliance: In case if the oral formulations fail to deliver required results, a hollow tube like device is often used which lures the blood into the penis to create a normal erection. The device is battery or manually operated and has a pump to be placed over the penis (also referred to as a penile pump, vacuum pump or penis-constriction vacuum device). This device has fewer risks and should be prescribed by your physician. Your doctor will always advise you a peculiar model and brand permitted by Food & Drug Administration (FDA) in lieu of your condition. Mal-advertised or devices published in print media may be harmful and are not recommended.

Penile implants. If drugs and the pump both fail, then a synthetic penile implant can be surgically implanted. Partially stiff or an expandable implant are commonly used because of their safety and efficacy in patients with ED.

Psychotherapy: Normal erection is the product of optimal physical stimulation as well as psychological excitation. Any factor that affects the physical and/ or psychological element of erection can present with erectile dysfunction. You should especially consider psychotherapy if:

  • You are under a lot of stress due to work, home, relationships or illness
  • You feel anxious or pressurized to perform well during the act of intercourse
  • You believe your illness or disease status may make you less attractive to your partner.
  • Other causes of psychological stress; such as marital discord, neglect from the partner, hatred for the partner etc.

Other tips that also help are:

  • Age & EDLifestyle choices: Try to modify your lifestyle and try not to underrate the importance of these modifications. These changes can bring drastic improvement in erectile dysfunction and general well-being, both.
  • Quit smoking. The usage of tobacco in any form can lead to thinning of the lumen of your blood vessels. Toxins and chemicals in cigarette smoke also interferes with the vascular system and depletion of nitrous oxide. These factors affect the gushing of the blood to the penis for an adequate erection. Quitting smoking may be not be easy, but can be achieved through professional guidance. You can take aid from medicines.
  • Decrease alcohol consumption.Two drinks per day is the limit for alcohol. More than this can exacerbate erectile dysfunction by harming your vessels.
  • Decreasing stress.Stress has a tendency to worsen the erectile dysfunction. Rescheduling and arranging your chores and setting an achievable target can help reduce the stress build up. Exercise like yoga can help contend with stress.
  • Daily workout.It makes the over-all blood flow better alleviating temper, gives energy boost and shed off stress. Daily walking is the simplest of exercise you could do.
  • Combat weariness.Adequate sleep and justified intercourse is going to help with prolong erection. The better you have rested, better will be the chances of effortless and sustained erection.

References:

  1. Thorve, V. S., Kshirsagar, A. D., Vyawahare, N. S., Joshi, V. S., Ingale, K. G., & Mohite, R. J. (2011). Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management. Journal of diabetes and its complications, 25(2), 129-136.
  2. Malavige, L. S., & Levy, J. C. (2009). Erectile dysfunction in diabetes mellitus. The journal of sexual medicine, 6(5), 1232-1247.
  3. McLaughlin, T., Harnett, J., Burhani, S., & Scott, B. (2005). Evaluation of erectile dysfunction therapy in patients previously nonadherent to long-term medications: a retrospective analysis of prescription claims. American journal of therapeutics, 12(6), 605-611.
  4. Boyanov, M. A., Boneva, Z., & Christov, V. G. (2003). Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency. The Aging Male, 6(1), 1-7.
  5. Kalinchenko, S. Y., Kozlov, G. I., Gontcharov, N. P., & Katsiya, G. V. (2003). Oral testosterone undecanoate reverses erectile dysfunction associated with diabetes mellitus in patients failing on sildenafil citrate therapy alone. The Aging Male, 6(2), 94-99.
  6. Brison, D., Seftel, A., & Sadeghi‐Nejad, H. (2013). The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction. The journal of sexual medicine, 10(4), 1124-1135.
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