Dr Larisse Badenhorst helps us understand why men who have diabetes may also suffer with diabetic erectile dysfunction.
Understanding erectile dysfunction
Erectile dysfunction (ED) is defined as the inability to get or maintain an erection firm enough for sex.
A lot must work together to get an erection. Men need healthy blood vessels, good blood supply, intact nerves, balanced and adequate hormones (these include oestrogen, testosterone and thyroid hormones), and a desire to be sexually stimulated.
This is a complex interaction of vascular, neurological, hormonal and psychological systems. It is therefore imperative to seek expert help when you are experiencing ED.
Screening, monitoring and appropriately treating diseases that are comorbid with erectile dysfunction is essential. This will enhance life quality and improved motivation in men with existing erectile dysfunction comorbidities or risk factors.
Diabetic erectile dysfunction
Erectile dysfunction is a common and distressing complication of diabetes. Both Type 1 and type 2 are risk factors for the development of erection problems.
Many unique characteristics distinguish these two, including insulin and cholesterol levels, obesity status and inflammatory agent profiles. The causes in diabetic erectile dysfunction are multifactorial and it is found that it is more severe and more resistant to treatment when compared with non-diabetics. Erectile dysfunction in diabetics develops 10 to 15 years before men without diabetes.
There are many associated factors, namely advancing age, duration of diabetes, poor glycaemic control, high blood pressure, high cholesterol, sedentary lifestyle (which pertains to lack of exercise and increased weight), smoking, presence of other diabetic complications, depression and other psychological diseases, prostate problems and low testosterone levels.
As important as these are in leading to erectile dysfunction, the medication used in treating these conditions are as important. There are a lot of medicines used to treat other conditions that can make erectile dysfunction worse.
It’s vital to screen for these other conditions in erectile dysfunction sufferers. Premature ejaculation and low libido is commonly associated with diabetic erectile dysfunction. It is important to see to these as well if present.
Diminished erection spontaneity, rigidity (firmness) and/or sustaining capability also negatively affect mood, self-esteem, and confidence. These can compromise motivation to be compliant with medications that treat diseases comorbid with erectile dysfunction.
Managing erectile dysfunction
Seeking medical expertise is imperative to treat the cause and comorbid conditions that can lead to ED. The following treatment is important in diabetic erectile dysfunction, but also important to be addressed in non-diabetics.
Optimising glucose levels is vital, especially in young men with diabetes. Lifestyle modifications are important; these include dietary changes, cessation of smoking and weight loss. Managing other comorbidities adequately is also of utmost importance.
As said before, optimising treatment of diabetes and other comorbidities, and reviewing all medication used much be done, as these can play a vital role in worsening erectile dysfunction.
Specific treatment for erectile dysfunction is phosphodiesterase type 5 inhibitors (PDE5I). These include tablets like Viagra, Cialis and Ciavor. These tablets work extremely well, but it is important to be prescribed by a medical professional who will make sure there are no contraindications in the use of these, as well as educating you on the side effects and risks.
Intracavernosal injections (these are injections administered directly into the penis) also work very well and are commonly used if PDE5I don’t work or contraindications to their use exist.
The dosage needed must be monitored by a medical expert because prolonged erections (known as priapism) can result from the use of the injectables and can have long-term effects.
Vacuum devices or pumps are also available. They draw blood into the penis to then obtain an erection and a ring is used to then keep the blood within the penis to maintain the erection.
A common problem is that the device is not used correctly and therefore a lot of men think that it doesn’t work.
Platelet rich plasma
A newer treatment available is platelet rich plasma (PRP). This involves using the person’s own blood products to promote healing and rejuvenation in certain areas of the body. It has gained a lot of popularity in sexual medicine but is still seen as experimental in treating things like erectile dysfunction.
Treating possible underlying psychological problems are very important and seen as key in patients with performance problems.
With the pharmaceutical advances and expanded knowledge of the effects of lifestyle on sexual health, there is seldom a reason for a man to suffer bad erections in this day and age. The earlier you treat, the better the outcome for your general health as well as long-term effects.
MEET THE EXPERT
Dr Larisse Badenhorst is a medical doctor. She joined the My Sexual Health team, in Bryanston, Gauteng, during May 2019 as general practitioner with a special interest in sexual health and HIV. For more info visit, www.drlarissebadenhorst.co.za
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