Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 31
ERECTILE DYSFUNCTION

Andrew JM Boulton MD FRCP, UK

Erectile dysfunction (ED) affects up to 50% of diabetic men at any time point. This can be defined as the inability to obtain and maintain an erection sufficient for penetration. In diabetes, ED is rarely the result of a single pathology, but more commonly a number of causes occur together in a single individual. Contributory causes to ED include peripheral autonomic neuropathy, peripheral vascular disease, iatrogenic, psychological problems and hormonal problems. In a case series published from my unit in the UK, of over 100 consecutive patients presenting with erectile dysfunction less than 1% were due to hormonal abnormalities. In diabetic men most cases of ED are secondary, that is subjects have previously had normal sexual function. As many diabetic patients are on multiple therapies it is important to exclude other medications as a contributory factor in the aetiopathogenesis of the ED in a particular individual. Commonly used drugs that might be implicated include the thiazide diuretics and beta-blockers. 

A careful history of the mode of onset and frequency of the ED is important in determining the causation. Those patients whose onset of ED was sudden after a particular life event (such as the diagnosis of type 2 diabetes) are likely to have a major psychological cause, where in those individuals where the onset is gradual but slowly progressive, that an organic cause is more likely. A simple assessment of the peripheral nervous system will help to identify those with neuropathy who are likely also to have autonomic dysfunction. Similarly a vascular history and examination of the blood supply to the lower extremity is helpful in determining whether vascular disease can be implicated.

Our approach to the management of ED in diabetes is firstly to exclude other causes such as local disease (Peyronie’s disease can of course occur in diabetes as well as in non-diabetic individuals). By a careful clinical examination, to try and alter medications that may be contributing and to have all patients assessed by a psychosexual counsellor. For those patients in whom the aetiology is thought to be a combination of psychosexual and organic causes (the commonest scenario) the management of ED has been revolutionised by the advent of oral therapies such as Sildenafil. In a recent study of Sildenafil in type 2 diabetes, we showed an excellent response rate of up to 70% in diabetic males with ED of any causation. Other treatments such as intracorporeal injection of vaser active substances, the intra-urethral system for erection (MUSE) and other such approaches are now rarely required. The use of local surgery for correction of vascular problems is extremely unusual in the twenty-first century.

In the management of ED, a careful history, examination and assessment of the psychological state of the individual is required and the advent of Sildenafil and other oral agents has made the outlook for ED in diabetes much better in the twenty-first century.

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