Aetiopathogenesis and Management of Impotence in Diabetic Males: Four Years Experience from a Combined Clinic

Abstract

The contribution of organic and psychogenic factors in the aetiopathogenesis of impotence was studied in a large number of diabetic males, to develop an algorithm for its management. We examined 110 consecutive patients who were referred to the Impotence Clinic of the Diabetes Centre. All patients were initially evaluated by a diabetologist and then underwent psychosexual assessment by a specialized psychiatrist. Patients with primarily organic disease were referred to a urologist for further management while those with psychogenic impotence received psychosexual counselling. Peripheral neuropathy was present in 71 (65%) and two or more autonomic tests were abnormal in 22 (20%) patients. Neuropathy was the only cause detected in 29 (27%) patients, the main cause in 22 (20%), and contributing, but not the main factor, in 20 (18%). Psychogenic factors were the only cause detected in 12 (11%) patients, the main cause in 26 (24%) and contributed in 19 (17%). Marital disharmony, medical treatment, and peripheral vascular disease were the main aetiopathogenic factors in the remaining cases. Psychosexual counselling resulted in successful intercourse in 17 (60%) out of the 24 treated patients and papaverine injections in 31 (61%) out of 56 treated patients. It is concluded that although organic factors are mainly responsible for the development of impotence in diabetic males, psychological factors contribute significantly and psychosexual assessment and counselling are essential adjuncts to its management. Treatment with papaverine injections is generally inexpensive and effective to overcome the multifactorial causes of erectile dysfunction in this population. An algorithm which may facilitate the investigation and treatment of impotent diabetic males is proposed.

A study of various factors associated with sexual dysfunction in males with type 2 diabetes mellitus

“…Veves et al study also suggest that age is not a significant factor associated with SD. 18 BMI (p = 0.717) and WC (p = 0.138) were not significantly different between two groups in the present study. Veves et al also showed that BMI and WC were not significantly associated with ED.…”

“…Veves et al also showed that BMI and WC were not significantly associated with ED. 18 The association of obesity with other forms of SD not known.…”

Nocturnal electrobioimpedance volumetric assessment in diabetic men with erectile dysfunction before and after tadalafil intake

“…The results have demonstrated that 84% of our diabetic patients with ED had abnormal patterns suggesting an organic (peripheral) basis for their ED. These results, therefore, agree with those of Veves et al, 15 who found that diabetic ED is mainly organic in 89% of their patients. However, our results looked higher than that reported by other investigators who used NPT and found that about 70% of their diabetic patients had abnormal findings suggesting organic factors which contributed to their impotence.…”

“…Some of the early results of this work were presented at the Sixth Congress of the European Federation of Sexology, Limassol, Cyprus, June [16][17][18][19][20] 2002 and the Seventh Asian Congress of Sexology, Raffles City, Singapore, November [14][15][16][17] 2002.…”

Lecture 5

“…7 It is also quite prevalent in Europe and elsewhere. In a study we performed, we noted the work by Dr Rajfer who measured decreased nitric oxide in the penises of rats exposed to cigarette smoke, 8 and the relationship noted by Dr Shabsigh between cigarette smoking and vascular impotence.…”