Erectile dysfunction and diabetes
Usually the common causes of erectile dysfunction (ED) are diabetes type 2 and arterial hypertension. Annually growing number of diagnosed erectile dysfunction and diabetes requires understanding of interconnection and etiopathogenetic mechanisms of these two illnesses.
Most often erectile dysfunction pathogenesis in men with diabetes is mixed. It means that with diabetes erectile dysfunction causes can be psychogenic, vasculogenic and (or) neurogenic risk factors.
Some facts prove the assumption that vascular and neurological disorders cause erectile dysfunction in men who suffer from diabetes. First of all, diabetes contributes to metabolic disorders that become the reason of destruction of endothelial and angiopathy. Angiopathy causes ischemic neuropathy, providing:
* pathologic changes in penile arteries;
* decreased sensitivity of the vegetative nervous system;
* decreased number of the nerve endings in the cavernous bodies of the penis.
Statistics testifies that risk of erectile dysfunction not only depends on duration of diabetes, but severity of metabolic disorders as well. When diabetes mellitus is characterized by hyperlipidemia and uncontrolled glycemia, the probability of erectile dysfunction increases by several times.
* Most often erectile dysfunction occurs if diabetes is associated with atherosclerotic vascular disease, nephropathy, retinopathy and (or) neuropathy.
* So the probability of violated mechanism of erection increases, during intensive insulin therapy, consumption of alcohol or usage of potent medicines.
* The lowest risk of erectile dysfunction occurs when effective metabolic control is achieved by means of diet only.
Noteworthy that erectile dysfunction can become the first symptom of diabetes. The thing is that multiple clinical studies demonstrate that namely when erectile dysfunction is diagnosed, it reveals violated metabolism of carbohydrates and glucose tolerance in some men. Despite the fact that organic factors have direct impact on the development of erectile dysfunction associated with diabetes, the inability to achieve erection may be also caused by depressive disorder.
Special place in pathogenesis of erectile dysfunction takes arterial hypotension. Because namely arterial hypotension associated with diabetes type I and type II may cause severe erectile dysfunction. Often erectile dysfunction with diabetes is caused by medications for treatment of arterial hypertension (antihypertensive drugs) but not by the disease itself.
Timely diagnosis and adequate treatment may help to prevent severe erectile dysfunction, as well as significantly improve sexual life of men. In modern practical urology, erectile dysfunction associated with diabetes mellitus can be cured by different drugs for erectile dysfunction treatment. These are for example, Sildenafil citrate, Tadalafil, Vardenafil, Avanafil and Alprostadil. All these erectile dysfunction drugs were approved by the FDA and can be prescribed for men with diabetes. It also involves men who take antidiabetic drugs (like diuretics, antihypertensive drugs, hypoglycemic drugs and insulin).
Alprostadil is among few drugs for erectile dysfunction treatment, which is not prescribed for oral use. Intracavernosal route of administration is used for Alprostadil injections, but micro-suppositories Alprostadil are injected into urethra. The advantage of drug Alprostadil is that erectile dysfunction is restored in several minutes after its use. But Alprostadil helps to achieve and maintain good erection for 60 minutes only.
Oral drugs for the treatment of erectile dysfunction are the most convenient to use and many men choose namely these kind of pills. The advantage of erectile dysfunction drugs is that they help man to express his sexual activity throughout 4 and more hours. So the most effective drug for the treatment of erectile dysfunction is Tadalafil (trade name Cialis) helps to achieve erection within 36 hours after oral administration.
If you decided to use drugs Alprostadil, Sildenafil, Tadalafil, Avanafil or Vardenafil for erectile dysfunction treatment, you may order their shipping on our online pharmacy. If you want to buy drugs for erectile dysfunction and diabetes online without prescription, feel free to ask our pharmacist your questions before making order. Before buying drugs for erectile dysfunction and diabetes treatment on our online pharmacy, you can ask your questions using email or live chat. Erectile dysfunction — the inability to get or maintain an erection firm enough for sex — is common in men who have diabetes. It can stem from problems caused by poor long-term blood sugar control, which damages nerves and blood vessels. Erectile dysfunction can also be linked to other conditions common in men with diabetes, such as high blood pressure and coronary artery disease.
Diabetes occurs when you have too much sugar circulating in your bloodstream. There are two main types of diabetes: type 1 diabetes, which affects less than 10 percent of those who have diabetes, and type 2 diabetes, which accounts for over 90 percent of diabetes cases. Type 2 diabetes often develops as a result of being overweight or inactive. Approximately 30 million Americans have diabetes, and about half of them are men.
An estimated 10 percent of men ages 40 to 70 have severe ED, and another 25 percent have moderate ED. ED tends to become more common as men age, though it isn’t an inevitable part of aging. For many men, other health conditions, such as diabetes, contribute to the likelihood of developing ED.
Until recently, erectile dysfunction (ED) was one of the most neglected complications of diabetes. In the past, physicians and patients were led to believe that declining sexual function was an inevitable consequence of advancing age or was brought on by emotional problems. This misconception, combined with men’s natural reluctance to discuss their sexual problems and physicians’ inexperience and unease with sexual issues, resulted in failure to directly address this problem with the majority of patients experiencing it.
Luckily, awareness of ED as a significant and common complication of diabetes has increased in recent years, mainly because of increasing knowledge of male sexual function and the rapidly expanding armamentarium of novel treatments being developed for impotence. Studies of ED suggest that its prevalence in men with diabetes ranges from 35–75% versus 26% in general population. The onset of ED also occurs 10–15 years earlier in men with diabetes than it does in sex-matched counterparts without diabetes.
A sexually competent male must have a series of events occur and multiple mechanisms intact for normal erectile function. He must 1) have desire for his sexual partner (libido), 2) be able to divert blood from the iliac artery into the corpora cavernosae to achieve penile tumescence and rigidity (erection) adequate for penetration, 3) discharge sperm and prostatic/seminal fluid through his urethra (ejaculation), and 4) experience a sense of pleasure (orgasm). A man is considered to have ED if he cannot achieve or sustain an erection of sufficient rigidity for sexual intercourse. Most men, at one time or another during their life, experience periodic or isolated sexual failures. However, the term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75% of the time.
Normal male sexual function requires a complex interaction of vascular, neurological, hormonal, and psychological systems. The initial obligatory event is acquisition and maintenance of an erect penis, which is a vascular phenomenon. Normal erections require blood flow into the corpora cavernosae and corpus spongiosum. As the blood accelerates, the pressure within the intracavernosal space increases dramatically to choke off penile venous outflow. This combination of increased intracavernosal blood flow and reduced venous outflow allows a man to acquire and maintain a firm erection.
Nitric oxide also plays a significant role. High levels of nitric oxide act as local neurotransmitters and facilitate the relaxation of intracavernosal trabeculae, thereby maximizing blood flow and penile engorgement. Loss of erection, or detumescence, occurs when nitric oxide–induced vasodilation ceases.
Low intracavernosal nitric oxide synthase levels are found in people with diabetes, smokers, and men with testosterone deficiency. Interference with oxygen delivery or nitric oxide synthesis can prevent intracavernosal blood pressure from rising to a level sufficient to impede emissary vein outflow, leading to an inability to acquire or sustain rigid erection. Examples include decreased blood flow and inadequate intracavernosal oxygen levels when atherosclerosis involves the hypogastric artery or other feeder vessels and conditions, such as diabetes, that are associated with suboptimal nitric oxide synthase activity.
Erections also require neural input to redirect blood flow into the corpora cavernosae. Psychogenic erections secondary to sexual images or auditory stimuli relay sensual input to the spinal cord at T-11 to L-2. Neural impulses flow to the pelvic vascular bed, redirecting blood flow into the corpora cavernosae. Reflex erections secondary to tactile stimulus to the penis or genital area activate a reflex arc with sacral roots at S2 to S4. Nocturnal erections occur during rapid-eye-movement (REM) sleep and occur 3–4 times nightly. Depressed men rarely experience REM sleep and therefore do not have nocturnal or early-morning erections.
The causes of ED are numerous but generally fall into two categories: organic or psychogenic. The organic causes can be subdivied into five categories: vascular, traumatic/postsurgical, neurological, endocrine-induced, and drug-induced. Examples of the psychogenic causes are depression, performance anxiety, and relationship problems. In people with diabetes, the main risk factors are neuropathy, vascular insufficiency, poor glycemic control, hypertension, low testosterone levels, and possibly a history of smoking.
What the research says
The Boston University Medical Center reports that about half of men who are diagnosed with type 2 diabetes will develop ED within five to 10 years of their diagnosis. If those men also have heart disease, their odds of becoming impotent are even greater.
However, the results of a 2014 study suggest that if you have diabetes but adopt a healthier lifestyle, you may reduce your diabetes symptoms and improve your sexual health. These lifestyle habits include eating a balanced diet and getting regular exercise.
What causes ED in men with diabetes?
The connection between diabetes and ED is related to your circulation and nervous system. Poorly controlled blood sugar levels can damage small blood vessels and nerves. Damage to the nerves that control sexual stimulation and response can impede a man’s ability to achieve an erection firm enough to have sexual intercourse. Reduced blood flow from damaged blood vessels can also contribute to ED.
Risk factors for erectile dysfunction
There are several risk factors that can increase your chance of diabetes complications, including ED. You may be more at risk if you:
- have poorly managed blood sugar
- are stressed
- have anxiety
- have depression
- eat a poor diet
- aren’t active
- are obese
- drink excessive amounts of alcohol
- have uncontrolled hypertension
- have an abnormal blood lipid profile
- take medications that list ED as a side effect
- take prescription drugs for high blood pressure, pain, or depression
Diagnosing erectile dysfunction
If you notice a change in the frequency or duration of your erections, tell your doctor or make an appointment with a urologist. It may not be easy to bring up these issues with your doctor, but reluctance to do so will only prevent you from getting the help that you need.
Your doctor can diagnose ED by reviewing your medical history and assessing your symptoms. They will likely perform a physical exam to check for possible nerve problems in the penis or testicles. Blood and urine tests can also help diagnose problems such as diabetes or low testosterone. They may be able to prescribe medication, as well as refer you to a healthcare professional specializing in sexual dysfunction. Several treatment options exist for ED. Your doctor can help you find the best option for you.
If you haven’t experienced any symptoms of ED, but you have been diagnosed with diabetes or heart disease, you should discuss the possibility of a future diagnosis with your doctor. They can help you determine which preventive steps you can take right now.
Treating erectile dysfunction
If you’re diagnosed with ED, your doctor will likely recommend an oral medication, such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). These prescription medications help improve blood flow to the penis and are generally well-tolerated by most men.
Having diabetes shouldn’t interfere with your ability to take one of these medications. They don’t interact negatively with diabetes drugs, such as Glucophage (metformin) or insulin.
Although there are other ED treatments, such as pumps and penile implants, you may want to try an oral medication first. These other treatments typically aren’t as effective and may cause additional complications.
Talk to an expert
- Tell your doctor what’s going on. Your doctor will consider underlying causes of your erectile dysfunction and can give you information about medication and other erectile dysfunction treatments. Find out your options.
- Ask what you need to do to control diabetes. Careful blood sugar control can prevent nerve and blood vessel damage that can lead to erectile dysfunction. Ask your doctor if you’re taking the right steps to manage your diabetes.
- Ask about other health problems. It’s common for men with diabetes to have other chronic conditions that can cause or worsen erectile dysfunction. Work with your doctor to make sure you’re addressing any other health problems.
- Check your medications. Ask your doctor if you’re taking any medications that might be worsening your erectile problems, such as drugs used to treat depression or high blood pressure. Making a change to your medications may help.
- Seek counseling. Anxiety and stress can worsen erectile dysfunction. A psychologist or other mental health provider can help you find ways to ease your stress level.
Consider your treatment options
- Oral medications. Erectile dysfunction medications include sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca), vardenafil (Levitra, Staxyn) or Avanafil (Stendra). These pills can help ease blood flow to your penis, making it easier to get and keep an erection. Check with your doctor to see whether one of these medications is a safe choice for you.
- Other medications. If pills aren’t a good option for you, your doctor might recommend a tiny suppository you insert into the tip of your penis before sex. Another possibility is medication you inject into the base or side of your penis. Like oral medications, these drugs increase blood flow that helps you get and maintain an erection.
- Vacuum-constriction device. This device, also called a penis pump or a vacuum pump, is a hollow tube you put over your penis. It uses a pump to draw blood into your penis to create an erection. This hand- or battery-powered device is simple to operate and has a low risk of problems.If a vacuum-constriction device is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer. Penis pumps available in magazines and sex ads might not be safe or effective.
- Penile implants. In cases where medications or a penis pump won’t work, a surgical penis implant might be an option. Semirigid or inflatable penile implants are a safe and effective treatment for many men with erectile dysfunction.
Make good lifestyle choices
- Stop smoking. Tobacco use, including smoking, narrows your blood vessels, which can lead to or worsen erectile dysfunction. Smoking can also decrease levels of the chemical nitric oxide, which signals your body to allow blood flow to your penis.If you’ve tried to quit on your own but couldn’t, don’t give up — ask for help. There are a number of strategies to help you quit, including medications.
- Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
- Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
How to prevent erectile dysfunction
There are several lifestyle changes that you can make to not only help with diabetes management, but also to lower your risk of ED. You can:
Control your blood sugar through your diet. Eating a diabetes-friendly diet will help you better control your blood sugar levels and lessen the amount of damage to your blood vessels and nerves. A proper diet geared at keeping your blood sugar levels in check can also improve your energy levels and mood, both of which can help reduce the risk of erectile dysfunction. You may consider working with a dietitian who is also a certified diabetes educator to help adjust your eating style.
Cut back on alcohol consumption. Drinking more than two drinks per day can damage your blood vessels and contribute to ED. Being even mildly intoxicated can also make it hard to achieve an erection and interfere with sexual function.
Stop smoking. Smoking narrows the blood vessels and decreases the levels of nitric oxide in your blood. This decreases blood flow to the penis, worsening erectile dysfunction.
Get active. Not only can adding regular exercise to your routine help you control your blood sugar levels, but it can also improve circulation, lower stress levels, and improve your energy levels. All of these can help combat ED.
Get more sleep. Fatigue is often to blame for sexual dysfunction. Ensuring that you get enough sleep each night can lower your risk of ED.
Keep your stress level down. Stress can interfere with sexual arousal and your ability to get an erection. Exercise, meditation, and setting aside time to do the things that you enjoy can help to keep your stress levels down and lessen your risk of ED. If you’re developing symptoms of anxiety or depression, consult your doctor. They may be able to refer you to a therapist who can help you work through anything that is causing you stress.
Diabetes is one of the most common causes of ED. Men who have Diabetes are three times more likely to have Erectile Dysfunction than men who do not have Diabetes. Among men with ED, those with Diabetes are likely to have experienced the problem as much as 10 to 15 years earlier than men without Diabetes. A recent study of a clinic population revealed that 5% of the men with ED also had undiagnosed Diabetes. The risk of ED increases with the number of years you have Diabetes and the severity of your Diabetes. Even though 20% to 75% of men with Diabetes have ED, it can be successfully managed in almost all men.
In regards to high blood pressure, this makes the heart work harder to pump blood which can prevent blood flow from reaching the penis and in turn prevent an erection. Recent reports say that close to 2 out of 3 men report a change in the quality of their erections if they have high blood pressure.
First, diabetes can cause damage to nerves (neuropathy) throughout your body-including the nerves to your penis. Damage to penile nerves can interfere with your body’s ability to send messages to and from the penis, which can lead to ED.
Second, Diabetes can aggravate a condition known as atherosclerosis, in which the blood vessels become narrow or harden. Narrowing or hardening of these blood vessels prevent blood flow into and out of your penis, which can cause ED.
Third, men with Diabetes need to control their blood sugar levels. When your blood sugar is not under control, your body does not produce enough Nitric Oxide (NO) and vascular tissues don’t respond as effectively to NO. When enough blood flows into the penis, penile veins close off and block the blood from flowing out. This process results in an erection. If your body does not produce enough NO or if your penile tissues do not respond to NO, the pressure of the blood flowing into your penis is not sufficient to trap the blood, you penis will not get hard.
Erectile dysfunction (ED) is a common problem amongst men who have diabetes affecting 35-75% of male diabetics.
Up to 75% of men suffering from diabetes will experience some degree of erectile dysfunction (erection problems) over the course of their lifetime. Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from the disease.
Over the age of 70, there is a 95% likelihood of facing difficulties with erectile function.
Pathology of Diabetic ED
The natural history of ED in people with diabetes is normally gradual and does not occur overnight. Both vascular and neurological mechanisms are most commonly involved in people with diabetes. Atherosclerosis in the penile and pudendal arteries limits the blood flow into the corpus cavernosum. Because of the loss of compliance in the cavernous trabeculae, the venous flow is also lost. This loss of flow results in the inability of the corpora cavernosae to expand and compress the outflow vessels.
Autonomic neuropathy is a major contributor to the high incidence of ED in people with diabetes. Norepinephrine- and acetylcholine-positive fibers in the corpus cavernosum have also been shown to be reduced in people with diabetes. This results in loss of the autonomic nerve–mediated muscle relaxation that is essential for erections.
The initial step in evaluating ED is a thorough sexual history and physical exam. The history can help in distinguishing between the primary and psychogenic causes. It is important to explore the onset, progression, and duration of the problem. If a man gives a history of “no sexual problems until one night,” the problem is most likely related to performance anxiety, disaffection, or an emotional problem. Aside from these causes, only radical prostatectomy or other overt genital tract trauma causes a sudden loss of male sexual function.
Nonsustained erection with detumescence after penetration is most commonly caused by anxiety or the vascular steel syndrome. In the vascular steel syndrome, blood is diverted from the engorged corpora cavernosae to accommodate the oxygen requirements of the thrusting pelvis. Questions should be asked regarding the presence or absence of nocturnal or morning erections and the ability to masturbate. Complete loss of nocturnal erections and the ability to masturbate are signs of neurological or vascular disease. It is important to remember that sexual desire is not lost with ED—only the ability to act on those emotions.
A medical history focused on risk factors, such as cigarette smoking, hypertension, alcoholism, drug abuse, trauma, and endocrine problems including hypothyroidism, low testosterone levels, and hyperprolactinemia, is very important. Commonly used drugs that disrupt male sexual function are spironolactone (Aldactone), sympathetic blockers such as clonidine (Catapres), guanethidine (Islemin), methyldopa (Aldomet), thiazide diuretics, most antidepressants, ketoconazole (Nizoral), cimetidine (Tagamet), alcohol, methadone, heroin, and cocaine. Finally, assessment of psychiatric history will help identify emotional issues such as interpersonal conflict, performance anxiety, depression, or anxiety.
The physical exam should focus on femoral and peripheral pulses, femoral bruits (vascular abnormalities), visual field defects (prolactinoma or pituitary mass), breast exam (hyperprolactinemia), penile strictures (Peyronie’s disease), testicle atrophy (testosterone deficiency), and asymmetry or masses (hypogonadism). A rectal exam allows for assessment of both the prostate and sphincter tone, abnormalities that are associated with autonomic dysfunction. Sacral and perineal neurological exam will help in assessing autonomic function.
Few simple laboratory tests can help identify obvious causes of organic ED. Initial labs should include HbA1c, free testosterone, thyroid function tests, and prolactin levels. However, patients who do not respond to pharmacological therapy or who may be candidates for surgical treatment may require more in-depth testing, including nocturnal penile tumescence testing, duplex Doppler imaging, somatosensory evoked potentials, or pudendal artery angiography.
Initially, preventive measures will help reduce the risk of developing ED. Improving glycemic control and hypertension, ceasing cigarette smoking, and reducing excessive alcohol intake have been shown to benefit patients with ED. Avoiding or substituting medications that may contribute to ED is also helpful.
Once ED has developed, oral agents are considered first-line therapy.
Sildenafil (Viagra) acts by blocking the catabolism of cGMP, resulting in an increase in nitric oxide. Fifty-six percent of diabetic men with ED experience improvement with sildenafil, compared to ∼70% of nondiabetic men with ED.
Sildenafil should be taken 1–2 h before intercourse. It is important to tell patients that the drug’s effectiveness requires sexual stimulation. One patient in our clinic recently complained that he had no effect from taking sildenafil. It was later discovered that he took the pill and then sat on his couch and read a book about how to grow tomatoes!
The initial dose for sildenafil is 50 mg, and the dose can be increased to 100 mg. (The pills can also be split in half with a pill cutter). Each pill costs $8–10, and patients can easily shop for the best price on the Internet.
Side effects of sildenafil are similar to those from taking niacin or any vasodilator, namely, headaches, lightheadedness, dizziness, and flushing. Some individuals experience a bluish tinge of their cornea, which makes them feel as if they are wearing light blue–tinted sunglasses. This effect can last for several hours. Syncope and myocardial infarction, the most serious side effects, are seen in men who are also taking nitrates for coronary heart disease. Sildenafil also has adverse effects in people with hypertrophic cardiomyopathy because a decrease in preload and after load in the cardiac output can increase the outflow obstruction, culminating in an unstable hemodynamic state.
Sildenafil is strongly contraindicated in men who take nitrates. Other men for whom its use holds potential hazards include those:
• with active coronary ischemia (e.g., positive exercise tolerance test) who are not taking nitrates
• with congestive heart failure (CHF) and borderline low blood pressure or low volume status
• with a complicated multi-drug antihypertensive regimen
• who use drugs that prolong the half-life of sildenafil by blocking CYP3A4
Another oral treatment that has been used with very little success is yohimbine (Yocon, Yohimex). This is an alpha 2 adrenergic receptor blocker that increases cholinergic and decreases adrenergic tone. It stimulates the mid-brain and increases libido. Optimal results occur when used in men with psychogenic ED. Side effects include anxiety and insomnia.
For those patients who are not candidates for oral therapy, intracavernosal injections are an acceptable alternative. Injections with alprostadil (Caverject) and papaverine (Genabid) have been used to induce erection.
This form of therapy has a response rate of well over 70%. The sympathetic nervous system normally maintains the penis in a flaccid or non-erect state. All of the vasoactive drugs, when injected into the corpora cavernosae, inhibit or override sympathetic inhibition to encourage relaxation of the smooth muscle trabeculae. The rush of blood engorges the penile corpora cavernosae sinusoidal spaces and creates an erection.
Patients who use this therapy should be trained under the guidance of a urologist, and sterile technique must be used. The drugs must be injected into the shaft of the penis and into one of the penile erectile bodies (corpus cavernosum) 10–15 min before intercourse. Most patients do not complain of pain upon injection. Sexual stimulation is not required, and resulting erections may last for hours. Side effects include penile pain and priapism. The cost is about $12–20 per injection.
Intraurethral alprostadil (Muse) provides a less invasive alternative to intrapenile injection. It is a pellet that is inserted 5–10 min before intercourse, and its effects last for 1 h. The response rate is ∼50–60%. It can be used twice daily but is not recommended for use with pregnant partners. Complications of priapism and penile fibrosis are less common than after alprostadil given by penile injection. The cost is ∼$18–24 per treatment.
Mechanical therapy is also effective and is especially well-accepted in men with stable partners. Vacuum-assisted erection devices are effective in creating erections in as much as 67% of cases. Vacuum pressure encourages increased arterial inflow, and occlusive tension rings discourage venous outflow from the penile corpus cavernosae. The penis placed inside the cylinder, a pump is used to produce a vacuum that pulls the blood into the penis. After the tension ring is slipped onto the base of the penis, the cylinder is removed. Erection lasts until the rings are removed. The one-time expense of this therapy is $120–300.
Penile prosthesis is a viable option for men who cannot use sildenafil and who find the injections or vacuum erection therapy distasteful. A non-adjustable semi-rigid prosthesis is easy to insert and has no postoperative mechanical problems. The inflatable prosthesis has a pump that is put in the testicular sac for on-demand inflation and deflation. Future versions will have a remote control device similar to a garage-door opener.
The primary complication of the surgical implantation is postoperative infection, which occurs in about 8% of cases involving diabetes. This infection can be difficult to treat and may require the removal of the device, although this occurs <3% of the time. The infection can also cause penile erosion, reduced penile sensation, and auto-inflation. Glycemic control should be optimized several weeks before surgery. Once a patient has surgery, none of the oral agents or vacuum devices will work because of the destroyed penile architecture.
Testosterone therapy with injections or patches should be tried in patients with documented low testosterone levels. Testosterone deficiency is a rare cause of impotence but should always be ruled out with a serum value.
Psychotherapy should be offered to the patients and their partners to address any interpersonal conflicts, because ED is a problem for couples—not just men.
ED is an under-recognized, under-discussed, and commonly untreated complication of diabetes. But it is also one of the most treatable diabetic complications. It is a “couples disorder,” affecting both the patient and his partner.
Knowledge of sexual dysfunction is rapidly expanding, and effective new treatments are now available, including oral medications, injectables drugs, vacuum devices, and inflatable prostheses. It is therefore important for both physicians and patients to be educated and aware of the causes and treatments of ED.
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