Navigation
Return Home
Tips for the
Visually Impaired
The 10k London Run
Stepping Out For IDDT
Red Sea Swim for IDDT
Donate
Mascot Name Competition
Hall Of Fame
About IDDT
About IDDT
Join IDDT
IDDT Campaigning
IDDT - International
Research Grants
Helping Developing Countries!
Contact Us
Mascot Name Competition
Diabetes & Insulin
Facts About Diabetes
Understanding
Your Diabetes
GM vs. Animal Insulin
Related Health Issues
Pregnancy Information
Living with Diabetes
Parents/Family Carers
Parents Bulletin
Important Warnings
Diabetes Commonsense
Parents/Family Carers
Reviews and Reports
Glossary Of Terms
IDDT News
IDDT News Releases
IDDT Newsletters
Publications
Press Cuttings
Site Navigation
External Links
Site Map
Insulin
Dependent
Diabetes
Trust
.
Impotence and Diabetes
Erectile dysfunction, more frequently referred to as impotence, is the persistent or recurrent inability to attain or maintain an erection. It is still something that is difficult or embarrassing to talk about, even within a relationship and so in many men it goes unreported. However, it is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of can now be treated effectively for intercourse to take place.
GENERAL INFORMATION ABOUT ERECTILE DYSFUNCTION
FACTS
· All men, with or without diabetes, experience difficulties in achieving an erection at some time in their lives.
· It affects at least one man in every 10.
· Overall 35% of men with diabetes have erectile dysfunction but this rises to 50% in men with diabetes over the age of 50.
Causes of erectile dysfunction?
Until about 20 years ago erectile dysfunction was thought to be almost entirely caused by psychological factors but it is now known that physical conditions are present in about 75% of sufferers and that in many men it may be caused by a combination of both.
Physical causes
If erectile dysfunction is of a physical cause then the onset is often gradual. These may be:
· Damage or diseases that affect the nerves that go to or from the penis.
· Vascular disease
· Side effects of medications, such as anti-hypertensive drugs. Sedatives, tranquillisers and anti-depressants may also be a cause.
· High cholesterol
· Too much alcoholism, some recreational drugs and heavy smoking.
· Neurological disease, eg stroke
· Chronic disease such as diabetes, kidney failure and liver failure.
Pyschological causes
If erectile dysfunction is with a sudden onset, then this suggests a pyschological cause such as:
· Stress and anxiety either at work or at home
· Marital conflicts
· Depression
ERECTILE DYSFUNCTION AND DIABETES
In the majority of cases of erectile dysfunction in men with diabetes the cause is physical rather than psychological and the most common cause is neuropathy - damage to the nerves that go to and from the penis. Physical causes themselves can also cause pyschological difficulties, so general counselling and discussion may be helpful.
Research [ref 1] in which 194 men with diabetes answered a questionnaire has shown that there is not only a problem about being open about these issues but there is also a lot of misunderstanding. It showed:
· 9% defined erectile dysfunction incorrectly
· 30% were unaware that it is a complication of diabetes
· 42% thought it was inevitable with age,
The study concluded that not sufficient emphasis is placed on impotence by health care professionals and they do not see it as important as other complications of diabetes. Healthcare professionals should raise this issue at diabetes annual check ups in order to provide people with the opportunity to raise what for them may be an embarrassing topic but also because erectile dysfunction can be a sign of diabetes control problems or other underlying health conditions. It can lead to a significant reduction in quality of life. An unfulfilling sex life can cause problems within that relationship.
Ref 1 Pract Diab 1997, Vol 4, No 4 The diabeteic males perception of erectile dysfunction, Cummings et al
What to do if erectile dysfunction develops
Important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of can now be treated effectively for intercourse to take place.
However it is first necessary to identify the problem and this means discussing the problem with your GP or diabetic clinic doctor. You may well be referred to a specialist or your GP practice may have a clinic within the surgery. Once referred to the specialist there will be a general assessment of your health and any medications you might be taking. Blood tests will also be carried out to check your diabetes control, hormone levels, blood pressure and general fitness. There may also be discussions about your previous sexual function and your relationship with your partner.
Psycho-sexual therapy
This may be recommended where pyschological factors are considered to be an important part of the causes of erectile dysfunction. It may be recommended in combination with other treatments.
Cochrane Review of psychosocial interventions for erectile dysfunction
A meta-analysis was carried out looking at all the research for erectile dysfunction to compare the effectiveness of psychological treatment [therapy] and treatment with oral drugs, vacuum devices or other psychological interventions. The reviewers searched for randomised controlled trials carried out between 1966 and 2007 and found 11 trials involving 398 men. Their conclusions were:
· group psychotherapy therapy improves erectile dysfunction in selected patients
· focused sex group therapy was more effective than no treatment
· men who received group therapy and Viagra [sildenafil] showed significant improvement of erectile dysfunction and were less likely than those receiving only Viagra to drop out
· no difference was found when comparing the effectiveness of psychological interventions with local injection and vacuum devices.
Ref: Melnik T, Soares BGO, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004825. DOI: 10.1002/14651858.CD004825.pub2.
Hormone treatments
Only a small number of cases of erectile dysfunction are caused by hormonal imbalance - most often reduced levels of testosterone. If this is the case, testosterone replacement can then be used.
Oral medications
There are now three drugs in tablet form on the market used to treat erectile dysfunction
· Viagra [Sildenafil, Pfzer]
· Cialis [Tadafil, Lilly]
· Vardenfil or Levitra [Bayer/GlaxoSmithKline]
They all act in the same way by helping the smooth muscles in the penis to relax so increasing the blood flow to the penis causing an erection. They will only work if the man is sexually stimulated. None of them should be taken in combination with each other.
Viagra - this was the first drug of its type on the market. It should be taken about an hour before sexual activity and on average takes 20 to 60 minutes to work and within a 4 to 6 hour period after taking the tablet, an erection should occur.
Side effects are usually mild and transient with the most common being headache and flushing. It should not be taken with other medicines unless the doctor says it is safe to do so.
Not to be taken by people who are taking medicines that contain nitrates, these are commonly prescribed for angina sufferers. Also people with the following conditions:
· Severe heart or liver problems
· Recent heart attack, stroke or low blood pressure
· Certain rare eye diseases eg retinitis pigmentosa.
Cialis - this is a new drug and within 30 minutes of taking it, 50% of men can get an erection if sexually stimulated and its effects last for 24 hours. So the manufacturers say that it will allow men with erectile dysfunction to choose when they want to have sex and will allow couples greater spontaneity. The publicity material says that in clinical trials Cialis worked in four out of five men.
Side effects are usually mild and transient, the most common being headache and indigestion. Less common side effects include stuffy nose, flushing. Myalgia, dizziness and backache.
Not to be taken by people who are taking medicines that contain nitrates. It should also not be taken by men with the following:
· Severe cardiac disease where sexual activity is inadvisable
· Heart attack in the last 90 days or significant heart failure in the last 6 months
· Stroke within the last 6 months
· Unstable angina
· Uncontrolled arrhythmias [irregular heart beat], low or untreated high blood pressure
Vardenafil or Levitra - the latest drug where clinical trials have shown that is effective and reliable in a wide range of men with erectile dysfunction. It normally works within 25-60 minutes and within a 5 hour period after taking.
Side effects are usually mild and transient with the most common being headache and flushing.
Not to be taken by people who are taking medicines that contain nitrates. It should also not be taken by men with the following:
· Severe cardiac disease where sexual activity is inadvisable
· Recent stroke, heart attack or low blood pressure
· Unstable angina
Research among men with diabetes 73% taking 20mg Vardenfil/Levitra showed a significant improvement in erections. Most adverse events were mild to moderate and transient - headache, flushing, rhinitis dyspepsia, nausea and dizziness.
COCHRANE REVIEW OF ERECTILE DYSFUNCTION DRUGS FOR MEN WITH DIABETES
There are three popular drugs to treat erectile dysfunction - sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), known as PDE-5 inhibitors. They have been found to be quite effective in the general population and now a Cochrane Review investigated whether these drugs are a safe and effective option for men with diabetes. The Review showed that although diabetes can cause a number of other chronic complications, such as heart disease and high blood pressure, these erectile dysfunction drugs were shown not to cause many adverse reactions in men with diabetes. The most common side effects were headache, flushing and upper respiratory tract complaints and flu-like symptoms.
The Cochrane Collaboration is an international organisation which evaluates systematic reviews and draws evidence-based conclusions about medical practice. In this case the Cochrane reviewers analysed eight studies that compared the effectiveness of the three PDE-5 medications to placebo. 1,759 men were involved with about half randomised to receive PDE-5 inhibitor therapy for 12 weeks in most studies and the rest to the placebo group. Overall, 80 percent of the participants had type 2 diabetes and the others had type 1 diabetes.
At the end of the studies men who took PDE-5 inhibitors showed improvements on all measures of erectile function, with an average difference of 26.7% more "successful intercourse attempts" compared to placebo groups. However, the Cochrane reviewers caution that men should use PDE-5 inhibitors only as directed by their physicians and should discuss interactions with other drugs that may be being taken and specific contraindications. The reviewers also warn that there is no concrete evidence that these medications are safe for the long term.
NHS Availabilty
All three are available on NHS prescription to men with diabetes but this is limited to four tables per month.
Other forms of treatment
Transurethral therapy
This is a needle-free form of treatment where a small pellet of a drug is introduced into the urethra [the tube that urine passes through] with a special applicator. The drug is absorbed through the urethra walls into the erectile tissue giving an erection in 5-10 minutes.
Intercavernosal injection therapy
The man and/or his partner are taught how to inject a drug directly into the penis. An erection usually occurs within 15 minutes.
Vacuum devices
These devices produce an erection using a hand or battery operated vacuum pump attached to a plastic cylinder.
Penile prosthesis
These are like splints that are surgically inserted into the penis. This causes destruction of the erectile tissue and should not be considered until other treatments have been tried.
Further information can be obtained from:
The Impotence Association
PO Box 10296
London SW17 9WH
Tel 020 8767 7791
www.impotence.org.uk
Relate
Herbert Gray
College
Little Church Street
Rugby
Warks CV21 3AP
Tel 01788 573241
www.relate.org.uk