Mise au point thérapeutique : la dysfonction érectile chez le diabétique

The lack of knowledge concerning the sexual health and the until recently reduced number of efficient treatment explains the reluctance of diabetes specialists to take care of erectile dysfunction (ED). ED related to diabetes is frequent and the patient demand for treatment is a reality. In spite dramatic progresses of simplified treatment, its management is still inadequate. Even so, a clear prioritization is now established: to resort or not to a specialized viewpoint according to simple or complex forms and etiologic (if possible) and/or symptomatic (“on demand”) treatments. PDE5 inhibitors (PDE5i) naturally became the first line treatment, easy to prescribe by any diabetologist in a majority of patients. However, in spite of PDE5i efficacy, reliability and good tolerance, the lower treatment response in diabetic patient leaves a significant space for intracavernous injections, or at least transitively. Generally, these ones are only indicate on second line, by a specialist of this field, but with the advantage of a possible reimbursement for the diabetic patient. More recently, the opportunity of low doses of PDE5i, given once-a-day, confers an innovative and effective alternative leading to a “demedicalisation” of this condition and may heal some ED. Anyway, ED treatment in diabetic patient has to be global, clinically based, tailored to the needs and the sexual life of each patient, with a follow-up of the results and possible adverse events.