Erectile dysfunction in diabetes

Abstract

Erectile dysfunction (ED) is one of the most prevalent chronic complications of diabetes, the one which is also severely impairing patients’ quality of life. However, it is also often undiagnosed and remains untreated. Erectile dysfunction in diabetes may result from vascular, neurological (autonomic neuropathy), hormonal (hypogonadism) and local lesions. Old age, sedentary lifestyle, obesity, dyslipidemia, hypertension, certain medications, smoking, alcohol abuse and depression are all important risk factors for ED development. International Index of Erectile Function-5 (IIEF-5) questionnaire is a useful self-administered tool for ED diagnosis. Management of ED includes improving blood glucose, blood pressure and lipids control as well as weight reduction, smoking cessation and decrease in alcohol intake. Psychological counselling should be offered to all patients. Phosphodiesterase inhibitors type 5 are drugs of choice, with sildenafil having been available for over 15 years. In majority (up to 70%) of patients these agents are effective in respect to improving erection quality. Other therapeutic options are prostaglandin E analog (alprostadil) injections or testosterone gel. In those patient in whom pharmacotherapy fails, medical devices or prosthesis can be used.