Erectile dysfunction, diabetes and cardiovascular risk

Abstract

Erectile dysfunction (ED) occurs in up to 75% of men with type 2 diabetes (T2DM) and has a complex pathogenesis owing to a combination of microvascular, macrovascular, endocrine and neuropathic disease. ED is established as an independent marker for the development of coronary artery disease (CAD) occurring on average 3 -5 years before the onset of CAD. Thus, timely detection of ED offers an opportunity for early intervention, thereby reducing morbidity associated with CAD. The average UK male, however, suffers for 3 years before discussing symptoms of ED with a healthcare professional. The National Institute for Health and Care Excellence (NICE) recommends an annual review of ED symptoms in susceptible patients with T2DM with an appropriate discussion of management options. Screening questions regarding ED were introduced in the 2013 Quality Outcome Framework but were removed by NHS England in 2014 on grounds of 'simplification'. Response to treatment strategies for ED is poor in diabetes, and poor glycaemic control, long duration of disease and severity of complications is predictive of a poor treatment response. The concomitant presence of hypogonadism in over 40% of men with T2DM also makes ED difficult to treat in this group. Further, ED and severe hypogonadism have been shown to independently predict mortality in T2DM. Treatment for ED is more likely to be effective if given early, although complex regimens may be required. Br J Diabetes 2016;16:52-57

Prevalence of sexual dysfunction and related factors among diabetes mellitus patients in Southwest Ethiopia

“…For instance, endocrine-related complication can lead to hypogonadism. Another study reported that sexual dysfunction is a marker for the development of chronic conditions such as DM and coronary artery disease [29]. These findings suggest that diabetic complications may play an important role in decreasing sexual function, and hence prevention of diabetic complications may be help to prevent sexual dysfunction in a patient with diabetes.…”

Erectile Dysfunction among Diabetic Patients at Parirenyatwa Group of Hospitals in Zimbabwe

“…The etiology of erectile dysfunction in hypertensive males is reported to be multifactorial and may be caused by vascular disease, decreased heart capacity, medication and/or other factors such as heavy smoking, psychological issues, obesity and physical inactivity (Salman et al 2016). Erectile dysfunction has been associated with use of β-blockers, thiazide diuretics, metformin, antidepressants, statins, fibrates and the drugs used for neuropathic pain such as pregabalin, gabapentin and opiate analgesics (Hackett 2016).…”

“…The increasing blood flow impedes venous return via compression of penile venules, thus maintaining an erection. Erectile dysfunction develop in diabetes mellitus patients due to an interplay of neuropathy, vasculopathy, hypogonadism, endothelial dysfunction and psychological factors (Hackett 2016).…”

Type 2 Diabetes and Testosterone Therapy

“…Men with T2DM have erectile dysfunction (ED) due to multiple comorbidities, most notably macro- and micro-vascular disease, autonomic and peripheral neuropathy, depression, and multiple medications in addition to HG [52]. Zitzmann et al [4953] found that falling testosterone levels significantly impact on ED around 8 nmol/L and Buvat et al [54] described a threshold of 10.4 nmol/L where testosterone therapy might salvage men who fail with phosphodiesterase type 5 (PDE5) inhibitors.…”