Erectile dysfunction in diabetes mellitus
- David K McCulloch, MD
David K McCulloch, MD
- Washington Permanente Medical Group
The inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse is a distressing and common symptom, affecting up to one-third of adult men . The prevalence of erectile dysfunction (ED) increases with age (figure 1), and it is common in men with systemic disorders such as hypertension, ischemic heart disease, or diabetes mellitus.
ED in men with diabetes mellitus will be reviewed here. A general discussion of normal erectile physiology and the treatment of male sexual dysfunction are presented separately. (See "Overview of male sexual dysfunction" and "Treatment of male sexual dysfunction".)
PREVALENCE AND NATURAL HISTORY
The frequency of erectile dysfunction (ED) in diabetes was evaluated in a survey of 541 men aged 20 to 59 years with diabetes attending a large community diabetes clinic . The prevalence of ED increased progressively with age, from 6 percent in men aged 20 to 24 years, to 52 percent in men aged 55 to 59 years. In addition to increasing age, the main factors associated with ED were peripheral or autonomic neuropathy, retinopathy, long duration of diabetes, and poor glycemic control.
Five years later, new ED had developed in 75 of 275 men . In contrast, only 11 of 128 men (9 percent) who initially had ED regained erectile function; these men were usually younger, had a shorter duration of diabetes, and had features suggesting psychogenic ED when first evaluated. Men in whom ED persisted were more likely to develop retinopathy or neuropathy than men with normal erectile function.
In a similar population study of 1040 Israeli men with diabetes who completed a self-report questionnaire, ED severity increased with diabetes duration, poor glycemic control, diuretic therapy, and presence of microvascular or cardiovascular disease . In addition, observational studies suggest that the presence of ED is a predictor of cardiovascular events in men with diabetes [5,6], as it is for men without diabetes. (See "Overview of male sexual dysfunction", section on 'Association with cardiovascular disease'.)
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