Sexual Dysfunction at the Onset of Type 2 Diabetes: The Interplay of Depression, Hormonal and Cardiovascular Factors

Abstract

Introduction Several data have emphasized the importance of early diagnosis of erectile dysfunction (ED) and meticulous cardiovascular investigation in the type 2 diabetic mellitus (T2DM) patients. Aim To estimate the prevalence of ED and its associated determinants in a sample of male patients with new or recently diagnosed T2DM. Methods The SUBITO-DE study is an observational, multicenter, prospective study involving 27 Italian diabetes centers. Male patients recently diagnosed with T2DM were consecutively interviewed by their attending physician at the diabetes care centers and asked whether they had experienced a change in their sexual function or found it unsatisfactory. Those responding positively were then invited to participate in the study. Main Outcome Measure Several hormonal and biochemical parameters were studied. Results A nonselected series of 1,503 patients was interviewed, 499 of which (mean age, 58.8 ± 8.8 years) entered the study, yielding a final enrolment rate of 33.3%. ED was classified as mild in 19.4%, mild-to-moderate in 15.4%, moderate in 10.4%, and severe in 21.6% of patients, respectively. In addition, premature ejaculation, delayed ejaculation, and hypoactive sexual desire (HSD) were comorbid in 28.3%, 32.9%, and 58.4%, respectively. Finally, hypogonadism, showed an estimated prevalence of almost 20%. Both organic (at least one chronic DM-associated complication) and psychological factors (severe depressive symptoms) increased the risk of ED. Severe depressive symptoms were also associated with ejaculatory problems, HSD, and hypogonadism. Conclusions A high prevalence of sexual dysfunction in men with recently diagnosed T2DM was detected. Early diagnosis of ED could help prevent emotional and physical discomfort in men and aid in identifying reversible cardiovascular risk factors. Screening of sexual dysfunction should become a part of routine care in the management of T2DM patients.

Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores

“…This finding is not surprising as it is consistent with the reduced efficacy seen for all available treatments for ED in patients with diabetes. This is likely due to the presence of multiple diabetes-associated complications, such as peripheral neuropathy and vasculopathy, including macroangiopathy, microangiopathy, and E U R O P E A N U R O L O G Y X X X ( 2 0 1 7 ) X X X -X X X endothelial dysfunction, which are not necessarily due to androgen deficiency [42][43][44][45]. In addition, TD induced by metabolic diseases is usually mild.…”

Erectile dysfunction, diabetes and cardiovascular risk

“…Corona et al conducted a prospective study of 499 patients with newly or recently diagnosed diabetes. 35 They reported that, around the time of diagnosis of diabetes, the prevalence of premature ejaculation, delayed ejaculation and low sexual desire was 28.3%, 32.9% and 58.4%, respectively. Sexual dysfunction preceded the diagnosis of diabetes in 30%, and 45.3% had never consulted about sexual dysfunction.…”

“…Sexual dysfunction preceded the diagnosis of diabetes in 30%, and 45.3% had never consulted about sexual dysfunction. 35 T2DM has also been associated with diseases that can indirectly cause sexual dysfunction, such as balanitis and Peyronie's disease. In a study conducted in 1,137 Danish patients, a higher HbA1c level was associated with an increased frequency of balanitis in patients with diabetes compared with those without (OR 1.25, CI 1.09 to 1.44), despite adjustment for age, sex, body mass index, blood pressure, complications and antihypertensive treatment.…”

Alprostadil in cream — a new option of treating erectile dysfunctions in diabetic patients

“…Importantly, a common incidence of sexual dysfunctions, usually erectile dysfunctions, has also been confirmed in men newly diagnosed with diabetes mellitus [13].…”

“…Early diagnosis of ED in patients with diabetes mellitus can help to prevent organic and emotional disorders in these men and help to identify cardiovascular risk factors. Screening for sexual dysfunction should become part of routine diabetes care [13]. Glycaemic control optimisation, treatment of accompanying disorders and lifestyle changes are the basis for therapeutic procedure in diabetic patients [4,5,8,11].…”