Erectile dysfunction in diabetic males: Plausible mechanisms and management strategies

SummaryErectile dysfunction (ED) is defined as a consistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. Although it is fairly common after the age of 40, the prevalence is 2 to 3 fold higher among diabetic patients than in non-diabetic counterparts. ED in diabetics is caused by micro and macro angiopathy of pelvic arteries and autonomic neuropathy involving the lumbo-sacral arc. Psychological factors such as depression, performance anxiety and interpersonal conflict also contribute to ED. Evaluation of the patient includes a detailed medical history, physical examination and relevant investigations. History should include questions on onset and duration of the problem, nature of medications and psychological issues. Physical examination should focus on assessment of peripheral vasculature, neurological system and external genitalia. Relevant investigations include assessment of glycemic and lipid control and hormonal profile. Detailed artery angiography and sacral evoked potential are occasionally required. Management of ED includes optimization of glycemic control and correction of cardiovascular risk factors. Oral sildenafil tablets are the mainstay of treatment. Novel mechanical therapies can be offered to those who are not candidates for sildenafil therapy.