Detailed investigation of the cause of impotence in 20 diabetic men

Abstract

To clarify the cause of their impotence, 20 diabetic patients underwent detailed assessments of: diabetic autonomic neuropathy (acetylcholine sweatspot test, pupil test‐PD%, five cardiovascular tests); vascular disease (radioisotope phallogram, response to intracorporeal papaverine); nocturnal penile rigidity; psychiatric disturbance (General Health Questionnaire). Results suggested cause as: vascular 7/20 (35%), vascular and autonomic neuropathy 7/20 (35%), autonomic neuropathy 3/20 (15%), psychiatric disturbance 2/20 (10%), beta‐blockers 1/20 (5%). The sweatspot test appeared to be the most sensitive assessment of autonomic neuropathy. Investigations suggested an alternative aetiology in all cases with a normal sweatspot test. In one patient with autonomic neuropathy, high deep‐artery velocity on Doppler but loss of papaverine‐induced erection, dynamic cavernosography revealed venous leakage; impotence was improved by surgical venous ligation. The results suggest that most impotence in diabetics has an organic basis. The sweatspot test (ideally in conjunction with cardiovascular tests and pupil test) and response to intracorporeal papaverine may identify and categorise most of these patients. Those with normal tests are unlikely to have organic disease and could be referred for psychosexual/psychiatric counselling. Doppler studies may identify those who need investigating for venous leakage. The others could then, in the first instance, be offered one of the recently described non‐invasive devices for overcoming diabetic impotence. Self‐administered intracorporeal papaverine may also be considered, but only a minority of diabetic patients seem to respond.

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

“…The impact of neurogenic, psychogenic and vascular factors, usually combined, in the pathogenesis of related complications have been demonstrated in a large number of studies. [1][2][3][4][5][6] Numerous medical researches have shown that, prevalence of sexual dysfunction in men as a consequence of the degenerative effects of diabetes on vascular and neurogenic structures ranges from 35 to 75%. 1,[7][8][9][10][11][12] It has also been documented that the etiology of ED may be neurogenic in up to 82% of diabetic men.…”

Frequency, severity, and risk factors related to sexual dysfunction in Chinese women with T2D

“…However, the small sample size of that study limits its generalizability. Moreover, that study excluded patients with severe acute or other chronic complications of diabetes, which are typically highly correlated with the sexual dysfunction reported in other studies . Therefore, we undertook the present multicenter study of Chinese women to characterize diabetes‐related FSD in China.…”

“…Moreover, that study excluded patients with severe acute or other chronic complications of diabetes, which are typically highly correlated with the sexual dysfunction reported in other studies. [12][13][14][15] Therefore, we undertook the present multicenter study of Chinese women to characterize diabetes-related FSD in China. The purpose of the study was to assess the frequency and severity of sexual dysfunction in patients with T2D compared with a control group of subjects who did not have diabetes.…”

Alcohol consumption in patients with diabetes mellitus

“…However, excessive alcohol consumption can result in dependency and have a deleterious effect on almost every system of the body. In patients with diabetes, excessive alcohol consumption can cause particular problems such as hypoglycaemia and hypoglycaemic unawareness[4] and may exacerbate the diabetic complications of peripheral neuropathy[5] and erectile dysfunction[6]. It is currently recommended that diabetic patients may consume up to 2–3 units of alcohol per day[7].…”