Know all about the causes and management of erectile dysfunction in Diabetes with our Endocrinology Experts, Dr. Vipin Mishra and Dr Vikram Hundia
Diabetes is the most common metabolic disease worldwide, occurring in 20% of adults in numerous countries, and studies show that the number of cases is increasing exponentially. Diabetes is a serious health hazard as it occurs with long term complications that could damage many organs of the body overtime, if not managed well. Diabetic subjects must follow an ideal lifestyle and control their blood sugar at the most desirable levels right from the day of diagnosis, all long-term diabetic complications are best prevented rather than treated.
One of the long-term complications is Erectile dysfunction (ED), which is highly common. Additionally, studies of ED suggest that the onset occurs 10–15 years earlier in men with diabetes compared to those without. A normal sexual performance requires a very fine interplay of many aspects of the masculine mind-system. It requires the right psychological inputs, proper hormonal actions, proper neural stimuli, unrestricted blood flow along with proper muscular functions (contraction and relaxation). In diabetes these processes are adversely affected in several ways.
To start, an ED is caused through obstruction to the blood flow, when smaller blood vessels don’t expand well when more blood is needed, and the larger blood vessels tend to get clogged by the process of atherosclerosis led by high cholesterol. Nerve dysfunction is also a common symptom of diabetes in which all types of nerves may be damaged. In diabetes damage to the nerves contributes to the problem of an ED. Additionally, depression is common in all chronic diseases including diabetes. Psychological issues often create a vicious cycle in which stress causes ED and ED causes more stress.
Hormonal issues caused by diabetes also play a role in causing ED in men. Testosterone, a male hormone, is often deficient in people with diabetes and obesity. Numerous diabetics are obese and both conditions tend to reduce testosterone levels. Hypothyroidism and high levels of prolactin are also common hormonal diseases caused by diabetes. Although they are in themselves not direct diabetic complications, but their co-occurrence in diabetic subjects is quite common. When present, they also contribute to ED. Medication could play an essential role in causing ED as a side effect. A large amount of medication given to manage diabetes and its complications may cause ED.
Ed in diabetics could also exist due to risk factors. A diabetic subject may be at a greater risk for ED in situations which include poor management of diabetes, obesity, co-existence of hypertension, high cholesterol and hypothyroidism, mental stress, anxiety or depression, smoking, excessive use of alcohol, sleep deprivation and a sedentary lifestyle.
“Erectile dysfunction, despite being a common male sexual health problem, remains significantly underdiagnosed and undertreated due to the social stigma around the subject and embarrassment from both patients and doctors in discussing this issue during consultation. Good management is key to treating ED and the first step is to overcome this barrier and discuss the issue with the doctor.”
Dr. Vikram Hundia, Consultant at Al Zahra Hospital Dubai.
An evaluation of ED requires a full medical checkup, social and psychological history, physical examination and laboratory evaluation. Once the evaluation is done, the treatment plan is initiated. Treatment of ED requires lifestyle modification, reduction or management of risk factors like obesity, diabetes, hypertension, cholesterol, smoking etc. Management may also involve treating organic or psychosexual dysfunction with either pharmacotherapy alone or in combination with psychosexual therapy.
If the patients do not respond to oral medication properly then vacuum constriction devices or intra-corporal injection therapy using drugs such as alprostadil can be beneficial and more effective. If the medical treatment is not providing results or improvements, then surgical treatment for ED like penile implants or penile arterial revascularization and venous ligation surgery may be considered after careful evaluation.
“Until recently, ED was one of the most neglected complications of diabetes. In the past, patients as well as their treating doctors believed that declining sexual function was an inevitable consequence of advancing age or that it was caused by emotional problems. This misconception, in association with men’s natural reluctance to discuss their sexual problems allowed the problem to grow unabated. At the same time most physicians were also inexperienced in treating or were uncomfortable in discussing the sexual issues. It ultimately resulted in failure to directly address this problem with the majority of patients experiencing it. The situation has now changed, ED can be well evaluated and adequately treated in most patients.”
Dr. Vipin Mishra, Consultant Endocrinologist at Al Zahra Hospital Dubai.