Male Erectile Failure and Diabetes

Erectile failure is particularly common in men with diabetes;
it affects up to 30%, and the prevalence increases further
with age, duration of diabetes, and the presence of microvascular
and macrovascular complications. It can be distressing
for both the man and his partner. There is now increasing
awareness of the importance of the problem, and the increased
effi cacy and availability of treatment makes it correctable
in more than 80% of cases.

Why is erectile dysfunction so common in men
with diabetes?

Normal erectile function is physiologically complex. It depends
on:
• normal psychological and endocrine status for libido and
arousal
• neural integrity
• normally responsive corpora cavernosal smooth muscle
• adequate arterial infl ow
• adequate veno-occlusive mechanisms.
These factors are all vulnerable in diabetes and its complications.
• Diabetes may cause psychological problems, and concomitant
endocrine and other disorders can also reduce libido and
arousal.
• Poor metabolic control, autonomic neuropathy, peripheral
vascular disease and cardiovascular risk factors such as
smoking and dyslipidaemia may all contribute.
• Hypertension is common in type 2 diabetes and, together
with increasingly intensive antihypertensive drug regimens,
may disturb erectile function.
• Corpora cavernosal smooth muscle may be directly affected
by microvascular disease and impaired endothelial cellmediated
relaxation.
• Other primary penile problems (e.g. balanitis, phimosis,
Peyronie’s disease) may be associated with diabetes.


Awareness, assessment and investigation

Diabetes service providers should screen high-risk men, or
should at least have posters on display and information leafl ets
available, to make men aware of the fact that the team is
cognizant of erectile dysfunction and can offer help.

History and examination

History and examination are essential. Clinicians should
ascertain the extent and likely causes of the problem, to enable
them to give an informed explanation and constructive
advice to patients, and to determine the appropriate treatment.
The history and examination (which must include the genitalia)
should determine the patient’s general health, degree of
metabolic control and complication status, and the relevance
of associated conditions.
The sexual history should aim to answer the following
questions.
• What exactly is the problem?
• Why is it a problem?
• What is the partner’s attitude?
• What does the patient and/or partner want to be done about
the problem?

Investigations

Investigations are necessary only when the history or examination
suggests a specifi c cause (e.g. endocrine) or further
assessment of associated conditions (particularly cardiovascular
disease and risk factors) is required. Many possible penile
investigations are listed in the literature (e.g. nocturnal tumescence
tests, cavernosography), but their results do not influence
initial medical treatment and they can be reserved
for research or further assessment before surgical corrective
treatment.