Erectile Dysfunction in Diabetes Mellitus

Abstract

Introduction Type 2 diabetes is reaching pandemic levels and young-onset type 2 diabetes is becoming increasingly common. Erectile dysfunction (ED) is a common and distressing complication of diabetes. The pathophysiology and management of diabetic ED is significantly different to nondiabetic ED. Aim To provide an update on the epidemiology, risk factors, pathophysiology, and management of diabetic ED. Method Literature for this review was obtained from Medline and Embase searches and from relevant text books. Main Outcome Measures A comprehensive review on epidemiology, risk factors, pathophysiolgy, and management of diabetic ED. Results Large differences in the reported prevalence of ED from 35% to 90% among diabetic men could be due to differences in methodology and population characteristics. Advancing age, duration of diabetes, poor glycaemic control, hypertension, hyperlipidemia, sedentary lifestyle, smoking, and presence of other diabetic complications have been shown to be associated with diabetic ED in cross-sectional studies. Diabetic ED is multifactorial in aetiology and is more severe and more resistant to treatment compared with nondiabetic ED. Optimized glycaemic control, management of associated comorbidities and lifestyle modifications are essential in all patients. Psychosexual and relationship counseling would be beneficial for men with such coexisting problems. Hypogonadism, commonly found in diabetes, may need identification and treatment. Maximal doses of phosphodiesterase type 5 (PDE5) inhibitors are often needed. Transurethral prostaglandins, intracavenorsal injections, vacuum devices, and penile implants are the available therapeutic options for nonresponders to PDE5 inhibitors and for whom PDE5 inhibitors are contraindicated. Premature ejaculation and reduced libido are conditions commonly associated with diabetic ED and should be identified and treated. Conclusions Aetiology of diabetic ED is multifactorial although the relative significance of these factors are not clear. A holistic approach is needed in the management of diabetic ED.

Reduced expression of SK3 and IK1 channel proteins in the cavernous tissue of diabetic rats

“…The prevalence of ED among diabetic men varies from 35% to 90% [1][2][3]. ED is three times more common in diabetic than in non-diabetic men, and may occur 10-15 years earlier in diabetic men.…”

ROS activates JNK-mediated autophagy to counteract apoptosis in mouse mesenchymal stem cells in vitro

“…Phosphodiesterase inhibitor 5 (PDEI5) (eg, sildenafil, vardenafil and tadalafil) represents the first-line therapeutic strategy for ED, but there are side effects of these drugs (eg, headache, flushing and diarrhea). Disappointing effects in diabetes patients compared with the general population have been reported [5][6][7] . Because stem cells can directionally differentiate into corpus cavernosum vascular endothelial cells and smooth muscle cells under a specific microenvironment, the transplantation of stem cells for treating diabetic ED was proposed as a potential therapeutic approach [8][9][10] .…”

Erectile dysfunction, diabetes and cardiovascular risk

“…Under normal circumstances, both biological and psychological factors work synchronously resulting in an erection. 5 Psychological arousal results in a biological cascade that involves parasympathetic activation and consequent nitric oxide (NO) release from local endothelial cells. NO mediates smooth muscle and vascular relaxation resulting in increased arterial flow to the penile corpora cavernosa.…”