Erectile dysfunction in diabetic patients

   Health news
  • By what signs do psychogenic impotence differ from organic impotence?
  • What widely used medications cause impotence?
  • How can impotence sufferers be helped today?

Half of all diabetic patients suffer from erectile dysfunction, but, for obvious reasons, patients often shy away from discussing sexual problems; in addition, due to the fault of inexperienced doctors in this matter, an atmosphere of diagnostic and therapeutic nihilism has arisen around this problem.

However, today knowledge about male sexual functions and their disorders is spreading rapidly and new methods of treating erectile dysfunction are emerging. Attention to this problem can have a positive impact on the quality of life.

Every man periodically faces sexual difficulties; the concept of “impotence” is used in cases when more than 75% of attempts to get an erection during sexual intercourse end in failure.

Pathophysiology

When sexual desire arises, blood from the iliac artery rushes into the cavernous bodies, the tension of the penis and rigidity sufficient to penetrate the vagina is achieved, then sperm, prostate secret and seminal fluid are ejected through the urethra and a feeling of pleasure (orgasm) is experienced.

Normal sexual function requires the interaction of the vascular, nervous, endocrine systems and a certain state of mind. Erection problems, or impotence, are a consequence of their mismatch.

The first thing required for male sexual activity, achieving and maintaining an erection is a vascular phenomenon triggered by nerve impulses and possible only in a certain hormonal environment and with the appropriate mood. As a complication of diabetes, erectile dysfunction develops as a result of the failure of the vascular system and impaired nervous regulation. Unlike many other complications of diabetes, impotence does not depend on the duration of the disease; it is more often found in patients with peripheral neuropathy. (ED is also associated with alcoholism, psychological problems, syphilis, multiple sclerosis.)

Symptoms and diagnosis

Organic impotence begins gradually. The first signs are a decrease in rigidity and frequency of erections, the appearance of incomplete erections, and then a complete loss of erectile function. Usually libido is preserved, so the disease significantly affects the quality of life, self-esteem and self-esteem, causes tension and difficulties in communication.

The fear of being untenable can in itself cause impotence. It is necessary to exclude the possibility of psychogenic impotence, if it is present, the patient is referred to a sex therapist.

The neurological component of impotence consists in insufficient relaxation of the smooth muscles of the penis due to dysfunction of the autonomic nervous system. Neurogenic impotence should also be excluded, since the etiology determines the choice of therapy.

Diseases of the micro- and macro-vessels leading to impotence may consist in stenosis of the arteries and failure of the veins. Stenosis of the internal sacral artery is the most common cause. Doppler ultrasound examination allows you to reliably assess the degree of blood supply disorders.

The ratio of pressure in the brachial artery and in the artery of the penis is an indicator of the degree of vascular disease: an index of less than 0.7 indicates a reduced blood supply.

Even with normal blood pressure in the penis at rest, it can drop below 0.15 with tension (to determine this, the patient is asked to bend and unbend the ankles for three minutes or until fatigue appears).

This phenomenon is called pelvic robbing. Clinically, such patients cannot maintain an erection during sexual intercourse. Constrictor rings help some patients (they are produced by Owen Mumford, Brook Hill, Woodstock, Oxford OX20 1TU).

Factors that enhance organic impotence should be identified and corrected. These include hormonal disorders (it is necessary to measure the serum levels of testosterone, prolactin, gonadotropin, thyroid hormones), insufficient correction of diabetes, penile abnormalities and sexually transmitted diseases.

Erectile dysfunction is a side effect of many common medications, so if possible, they should be canceled.

Treatment

A general practitioner can identify the problem (usually with an annual survey), conduct a differential diagnosis of organic and psychogenic impotence, and also try a number of therapeutic procedures, including vacuum pumps, constrictor rings and yohimbine. In the absence of a result, the patient is referred to a specialized clinic for further examination and treatment.

New approaches

New, non-invasive methods of treatment deserve attention.

An alternative method of using alprostadiol. The use of alprostadil in the form of an intraurethral suppository with an applicator was studied. The study was conducted by a double-blind method with placebo control and covered 1511 men with various organic erectile dysfunction; 996 (66%) responded to intraurethral alprostadil with an erection sufficient for sexual intercourse. Subsequently, they were selectively given alprostadil or placebo.

Sexual intercourse was more successful when using alprostadil (65% vs. 19%). According to reports, 7 out of 10 cases of alprostadil use end in successful sexual intercourse. Systemic effects are unstable, and complications such as priapism and fibrosis of the penis are less common than with alprostadil injections, but occasionally irritation of the vaginal mucosa is noted. The accumulated experience of such use of alprostadil is still too small.

Local vasodilators. The use of local vasodilators is not innovative. In some cases, glyceryl trinitrate is successfully used. What is new is the successfully applied combination of three local vasodilators with different mechanisms of action (for example, 3% aminophyllin, 0.25% isosorbide dinitrate and 0.05% codergocrine mesylate), the ointment is applied to the head and body of the penis. A general practitioner may try to prescribe alprostadil ointment and yohimbine in the absence of hypertension in the patient.

The loss of tension of the penis during penetration into the vagina (pelvic theft syndrome and / or venous insufficiency) is overcome with the help of constrictor rings in combination with a combined alprostadil ointment.

Oral remedies for the treatment of erectile dysfunction. Sildenafil. Erection depends on the relaxation of smooth muscle cells of cavernous bodies caused by nitric oxide and its secondary mediator – cyclic guanosine monophosphate.

Sildenafil is a drug for oral administration that has an inhibitory effect against the enzyme phosphodiesterase, which is the main enzyme in human cavernous bodies. The result of taking this drug should be increased relaxation of smooth muscle cells of cavernous bodies. Preliminary studies indicate good tolerability of the drug and its effectiveness in erectile dysfunction.

No Comments

Leave a Reply

Your email address will not be published.