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How does diabetes cause erectile dysfunction?
Diabetes is a chronic condition wherein the body is unable to produce or respond to insulin properly, resulting in high blood sugar levels. There are several tests that can be used to diagnose diabetes, including fasting blood sugar tests, oral glucose tolerance tests, and A1C tests.
The criteria for determining diabetes include a fasting glucose level of 126 mg/dL or greater on two occasions, a random glucose level of 200 mg/dL or greater with symptoms, or a hemoglobin A1c (HbA1c) level of 6.5% or higher.
Diabetes can have many negative effects on men’s health, Male dysfunction is a widely recognized comorbidity in men with diabetes. It is estimated that about 35% to 75% of men with diabetes will experience at least some degree of erectile dysfunction during their lifetime. Men with diabetes tend to develop erectile dysfunction 10 to 15 years earlier than men without diabetes.
It can manifest in different ways, including hypoactive sexual desire, penile erectile dysfunction (ED), and ejaculatory dysfunction (PE). Diabetes can elicit various pathophysiological changes that significantly affect sexual function, including:
- Reproductive endocrine aspects that lead to decreased testosterone levels and androgen receptor sensitivity;
- Hemodynamic aspects that cause increased blood viscosity, thickened and less elastic blood vessel walls;
- Degeneration of peripheral nerves, resulting in decreased sensation and signaling of sexual stimuli;
- Lesions of the cavernous muscle and white membranes, which cause difficulties in erection, weak erection, painful erection, and other related symptoms;
- Nerve and muscle tissue lesions related to ejaculation, leading to damage to the bulbocavernosus muscle, sciatic cavernous muscle, and pelvic floor muscle groups, affecting penile erection and ejaculation;
Diabetes often results in emotional changes in patients, including anxiety and depression, which can lead to and aggravate various problems in sexual function.
How to treat diabetic erectile dysfunction？
Effective management of diabetic erectile dysfunction involves controlling blood glucose, selecting an appropriate treatment plan based on effectiveness, safety, cost, and patient preference, and seeking medical guidance when necessary.
Oral drug therapy
When it comes to treating erectile dysfunction with oral medications, phosphodiesterase type 5 inhibitors (PDE5i) are the recommended first-line treatment option for most patients. Of these drugs, sildenafil is commonly prescribed at an effective dose of 50-100 mg. It should be taken 30-60 minutes before sexual activity, and the dose can be adjusted up or down based on the patient’s response and any side effects experienced. However, patients should not exceed one dose per day.
Tadalafil has the unique advantage of having effects that last up to 36 hours and are not impacted by food intake. The starting dose for most patients is 10-20 mg or 5 mg daily. Patients need to be aware that taking tadalafil with heavy alcohol consumption may increase side effects such as decreased blood pressure when standing, increased heart rate, dizziness, and headache.
Vardenafil is typically prescribed at a starting dose of 10 mg, with an effective dose range of 5-20 mg. It generally takes effect within 30 minutes and up to one-third of patients may experience a satisfactory erection within 15 minutes of ingestion. However, a heavy meal may diminish its effects.
Avanafil is a newer PDE5i drug that is highly selective and has been approved for ED on demand at doses of 50 mg, 100 mg, and 200 mg. It has a similar mechanism of action to other PDE5i drugs and may be more effective for some patients.
When selecting the appropriate drug for ED treatment, patients need to consider their frequency of sexual activity and determine if they need occasional or regular treatment. They should also be informed of the long- or short-acting nature of each drug, any possible side effects, and how to properly use it. Overall, PDE5i drugs are safe and effective for most men with ED and can play an important role in improving sexual function and quality of life.
Safety issues of PDE5i
PDE5i drugs such as sildenafil, tadalafil, vardenafil, and avanafil are generally well-tolerated and safe for most men with erectile dysfunction. Cardiovascular safety is an important consideration for patients with underlying heart conditions, but studies have shown that the incidence of myocardial infarction is not increased in patients receiving PDE5i. Exercise tests have also demonstrated that PDE5i does not have adverse effects on total exercise time or ischemic time in patients with stable angina.
However, it is important to note that the combination of PDE5i with organic nitrates is an absolute contraindication due to the risk of severe hypotension. Patients must also use caution when combining PDE5i with antihypertensive agents such as ACE inhibitors, beta-blockers, and calcium blockers, as there may be a small reduction in blood pressure.
Furthermore, PDE5i can interact with alpha-blockers, leading to upright hypotension in some cases. Patients should inform their healthcare provider if they are taking alpha-blockers when considering using PDE5i medication for erectile dysfunction. Overall, while PDE5i drugs are generally safe, patients should be aware of potential interactions and consult with their healthcare provider before using these medications.
Shockwave therapy
Shockwave therapy, also known as extracorporeal low-energy shock wave therapy (LI-ESWT), has shown promising results in treating vasogenic erectile dysfunction (ED). LI-ESWT has been found to significantly improve the International Index of Erectile Function (IIEF) and erectile hardness scores in patients with mild vascular ED. However, it does not appear to improve penile hemodynamic parameters. One of the significant benefits of LI-ESWT is that it can improve erection quality in patients with severe ED who are unresponsive or under-responsive to PDE5 inhibitors, reducing the need for more invasive treatments.
It’s crucial that patients receive adequate counseling before undergoing LI-ESWT treatment. It’s important to understand that shockwave therapy is a non-invasive treatment that may need multiple sessions to be effective. It may also cause minor side effects, such as tingling and tenderness in the treated area.
shockwave therapy is a promising alternative for patients with vasogenic ED who do not respond well to traditional treatments. Before receiving LI-ESWT, you should discuss the benefits and potential risks of LI-ESWT with your healthcare provider to determine if this treatment is appropriate for you.
Psychosexual counseling and treatment
Psychosexual counseling and treatment can be a helpful approach for patients who suffer from erectile dysfunction and also have psychological issues. Along with other treatments, it can be used to enhance sexual satisfaction for couples and function for the individual.
There are various forms of psychotherapy that can be applied, such as sexual skills training, marriage therapy, and psychosexual education. Cognitive and Behavioral Therapy (CBT) is another effective form of psychotherapy that includes couple forms.
By addressing both physiological and psychological factors, psychosexual counseling can provide a comprehensive treatment plan for patients with ED.
Hormone replacement therapy
Hormone replacement therapy, or HRT, involves the use of hormones to supplement or replace missing or deficient hormones in the body. In the case of erectile dysfunction related to hormonal issues, HRT is often used to supplement testosterone, the primary male hormone responsible for sexual development and function.
Hypogonadism, a condition characterized by low testosterone levels, can result in erectile dysfunction. Primary hypogonadism is caused by testicular failure, whereas secondary hypogonadism is often due to problems with the pituitary gland or hypothalamus in the brain. In both cases, HRT can help to restore testosterone levels and improve sexual function.
Testosterone preparations used in HRT may be administered through various routes, including injections, transdermal patches, topical gels, and pellets. While HRT can be an effective treatment for erectile dysfunction resulting from hypogonadism, it is not appropriate for all cases of erectile dysfunction and should only be prescribed by a healthcare professional after a thorough evaluation.
It is important to note that hormone replacement therapy may come with potential risks and side effects, such as an increased risk of blood clots, stroke, prostate enlargement, and breast cancer. Therefore, before starting this treatment. you should discuss the potential risks and benefits of HRT with a healthcare provider.
Surgical treatment
Surgical treatment can be considered a viable option for patients with severe erectile dysfunction who have not responded to other treatments. This approach includes two main procedures: vascular surgery and penile prosthesis implantation.
Vascular surgery is a viable option for patients with ED caused by vascular lesions, and the procedure is chosen based on the nature, location, and extent of the lesion. This procedure can restore arterial blood flow and improve erectile function.
A penile prosthesis implantation is a suitable option for patients with organic and severe psychological erectile dysfunction who have failed to respond to other methods. There are different types of penile prostheses available, including semi-rigid rod penile prostheses, expandable three-component prostheses, expandable two-component prostheses, and expandable single-component prostheses. The expandable three-component prosthesis is the most commonly used, but it is expensive to remove in the case of mechanical failure.
Conclusion
Male diabetes and erectile dysfunction is a real challenge that many men face. However, with early diagnosis, monitoring, and the right treatment approach, men with diabetes can manage the condition and continue to enjoy healthy and satisfying sex life. With the right guidance and support from healthcare professionals, men can overcome this challenge and live fulfilling lives.
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