Treatment Options for Erectile Dysfunction in Patients with Diabetes

According to a new study reported in the peer reviewed The American Journal of Medicine (1), investigators suggested that the overall prevalence of erectile dysfunction in males is about 18.4%. It is logical to assume that erectile difficulty or sexual dysfunction is more prevalent in certain age groups or individuals with some risk factors. For example, the sexual drive and vigor decreases with advancing age which is physiological. However, erectile dysfunction due to aging is never physiological and responds very well to therapeutic interventions.

Some of the most frequently reported secondary causes of erectile dysfunction are:

• Chronic and poorly controlled medical or metabolic disorders (such as hypertension, diabetes, hypercholesterolemia)
• An acute or chronic injury to the spine or genital region
• Psychological factors (such as marital discord, depression, anxiety disorder, stress etc.)

In addition, certain lifestyle choices or habits can also increase the risk of erectile dysfunction in males (such as chronic alcohol ingestion, use of illicit drugs or tobacco abuse etc.).

 

Erectile Dysfunction in Diabetics

Study conducted by Selvin and associates (1) suggested that the prevalence of erectile dysfunction in diabetic males is about 51.3% (such that one of every two diabetic males experience some degree of difficulty in achieving or maintaining normal erection). There are a number of factors that may explain the pathophysiology of sexual deficits in the setting of long standing diabetes.

Abnormally high blood glucose levels in the circulation is the hallmark feature of diabetes. Unfortunately, sugar molecules are osmotic in character (i.e. glucose is capable of attracting water molecules leading to cellular swelling and loss of function in the long term). After extensive research and clinical analysis, investigators suggest that poorly managed diabetes can lead to erectile dysfunction by a number of mechanisms:

• Damage to Blood Vessels and Sinuses That Are Responsible for Erection: Integrity and receptiveness of blood vessels is one of the most important elements in the maintenance of normal erection. Unfortunately, due to osmotic swelling of vascular cells, the risk of vasculitis (inflammation of blood vessel walls) increases significantly. Needless to say that long standing vasculitis affects the patency and receptiveness of blood vessels; thereby leading to erectile difficulty.
• Damage to Nerves: Nervous stimulation and activation is responsible for the initiation of sexual cascade. Yet, long standing diabetes leads to neuropathy (also referred to as nervous dysfunction) due to osmotic damage to nerve sheaths.
• Poor Energy and Easy Fatigability: Sexual stimulation is psychological at first; however, after psychological and neurological sexual arousal, the next element of sexual activity is mainly physical. It has been observed that nutritional dysfunction and abnormal metabolism of glucose in the body greatly affects energy levels and stamina in diabetic males; leading to sexual and erectile dysfunction.

 

Treatment Options for Erectile Dysfunction in Diabetic Males

There are a number of therapeutic as well as over-the-counter options that can be employed for the restoration or management of erectile function in diabetic males. Most safest and recommended modalities include:

• Phosphodiesterase Inhibitors: This include agents like Viagra, sildenafil and other forms of phosphodiesterase inhibitors. In most case, PDE-5 inhibitors are not just safe but are also fairly effective in the long term management. It has however observed that the success rate or efficacy is slightly low in diabetic males when compared to non-diabetics.
• Intracavernous Injections: Direct administration of active drug agents (such as Alprostadil or Phentolamine mesylate) in the penile tissue is usually considered as the second-line therapy (ideal for males who do not respond well to the oral PDE-5 agents). The success rate is usually 70 to 80%.
• Vacuum Assisted Devices: These devices are linked with a manual vacuum pump to mechanically stimulate the cavernous tissue for a sustained erection. Most patients respond very well to vacuum assisted devices.
• Penile Implants: This type of intervention is usually reserved for males who have advanced or severe erectile dysfunction. Penile implants are available as temporary variety (to be used occasionally) or surgical variety (in which the implant is surgically implanted for permanent relief).

 

Life Style Modifications and Home Remedies for Diabetic Neuropathy

It has been observed that optimal control of blood sugar levels can significantly improve the sexual function in males by delaying the onset of diabetic complications such as neuropathy or vascular disturbances. Additionally, certain other interventions can also improve the outcome in the patients.

1. Blood Pressure Monitoring: Research and clinical data indicates that hypertension acts as a two-edged sword in the pathogenesis of erectile dysfunction. Chronic hypertension is almost always accompanied with some degree of sexual dysfunction. In addition, antihypertensive medications further aggravates the sexual dysfunction. Therefore if you are a diabetic, it is highly recommended to maintain your blood pressure under optimal limits. It is also advised to speak to your doctor in detail about your pharmacological regimen, co-existing health issues and remedies to maintain healthy sex life.
2. Food Choices: Intake of a balanced diet is essential in maintaining the blood sugar levels under normal limits. In addition, healthcare providers also recommend antioxidants and other vital micronutrients to maintain vascular health and sexual function such as selenium, zinc and vitamin C.
3. Physical Activities: It is recommended to maintain a healthy and functional lifestyle to improve the quality of life. Healthcare providers recommend daily exercise or other forms of physical activity for 20-30 minutes each day to improve blood sugar regulation and neurological health.
4. Quit Smoking: Diabetic patient who smoke are at much higher risk of developing erectile issues. Cessation of smoking also helps in decreasing the risk of stroke and heart diseases in diabetic patients.

If you are experiencing erectile dysfunction in the setting of diabetes, it is highly recommended to seek medical intervention and drug evaluation to ascertain if your ED is due to advanced complications of diabetes or drug-mediated adverse effects of hypoglycemic agents.

 

References:

1. Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the US. The American journal of medicine, 120(2), 151-157.
2. Basu, A., & Ryder, R. E. (2004). New treatment options for erectile dysfunction in patients with diabetes mellitus. Drugs, 64(23), 2667-2688.
3. 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.
4. Pahlajani, G., Raina, R., Jones, S., Ali, M., & Zippe, C. (2012). Vacuum erection devices revisited: its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. The journal of sexual medicine, 9(4), 1182-1189.
5. Ryan, J. G., & Gajraj, J. (2012). Erectile dysfunction and its association with metabolic syndrome and endothelial function among patients with type 2 diabetes mellitus. Journal of Diabetes and its Complications, 26(2), 141-147.