details about Erectile dysfunction and diabetes

Why Do Men With Diabetes Have Erectile Dysfunction?

The causes of erectile dysfunction in men with diabetes are complex and include impaired nerves, blood vessels, and muscle function. To get an erection, men need blood vessels, nerves, healthy male hormones and the desire to be sexually stimulated. Diabetes can damage the blood vessels and nerves that control erection. Therefore, even if you have normal amounts of male hormones and want to have sex, you may not be able to get a firm erection.

What treatments are available for human with diabetes and erectile dysfunction?
Men with diabetes who have trouble getting and / or maintaining an erection may take oral medications such as sildenafil (Revato, Viagra), tadalafil (Adcirica, Halis), avanafil (Sandra) or vardenafil. (Levitra, Staxin).

Talk to your doctor to determine the good treatment.

 

So which treatment is best? It depends on many factors, including men’s health and their ability to tolerate treatment. Ask your doctor if you need to see a specialist (urologist) to determine the best treatment for your condition.

Erectile dysfunction:
Erectile Dysfunction (ED) – unable to have or maintain an erection – is a major sexual complaint for men with diabetes. Of course, all men sometimes have erection problems, especially as they get older. But if you are a diabetic, you are twice as likely to have erectile dysfunction at an earlier age.

You have ED if you have problems with erections one to four times. Damage to the nerves and arteries as a result of poor diabetes control is a likely cause because it disrupts blood flow to your penis. You are also more likely to have heart disease due to this damage, which slows down blood flow to the heart.

Erectile dysfunction can suppress your mood. It can reduce your self-esteem, make you feel depressed and sleepy and cause stress between you and your partner.

On the other hand, if you simply do not want to have sex, you may have low testosterone levels. Like erectile dysfunction, low testosterone is more likely in men as they age. But diabetes, especially if you are type 2 or overweight (or both), doubles your chances of having it.

You can experience the effects of low testosterone in many areas of your life. Your energy, muscle strength and mood can be as low as your sexual desire. You may have fewer and fewer erections.

Diabetes and Erectile Dysfunction:

Until recently, erectile dysfunction (ED) was one of the most overlooked complications of diabetes. In the past, doctors and patients believed that the decline in sexual function was an inevitable consequence of old age or that it was caused by emotional problems. This misconception, combined with the natural reluctance of men to discuss their sexual problems and the inexperience and discomfort of doctors who have sexual problems, has resulted in the inability to address this problem directly with the majority of patients experiencing it.

Fortunately, awareness of erectile dysfunction as an important and common complication of diabetes has increased in recent years, mainly due to better knowledge of male sexual function and a rapid arsenal of new treatments being developed. for helplessness. Erectile dysfunction studies have suggested that its prevalence in men with diabetes ranges from 35 to 75% compared to 26% in the general population. The onset of erectile dysfunction also occurs 10 to 15 years earlier in men with diabetes than in their non-diabetic counterparts.

A sexually competent man must have a series of events and more intact mechanisms for normal erectile function

Physiology

Normal sexual function in men requires a complex interaction of vascular, neurological, hormonal and psychological systems. The initial mandatory event is the acquisition and maintenance of a correct penis, which is a vascular phenomenon. Normal erections require blood flow to the corpora cavernosa and the spongy body. As the blood speeds up, the pressure inside the intra-cavity space increases significantly to drain the venous flow of the penis. This combination of increased intracavernous blood flow and reduced venous flow allows people to obtain and maintain a firm erection.

Nitric oxide also plays an important role. High levels of nitric oxide act as local neurotransmitters and facilitate the relaxation of intracavernous trabeculae, thereby increasing blood flow and congestion in the penis. Loss of erection or perversion occurs when vasodilation caused by nitric oxide ceases.

Low levels of intracavernous nitric oxide synthase are found in people with diabetes, smokers and men with testosterone deficiency. Obstacles to oxygen supply or nitric oxide synthesis can prevent intracavernosal blood pressure from rising to a level sufficient to prevent outflow of veins, leading to the inability to obtain or maintain a firm erection. Examples include decreased blood flow and inadequate intracavernous oxygen level when atherosclerosis involves the hypogastric artery or other vessels and eating conditions, such as diabetes, that are associated with suboptimal activity of nitric oxide synthase.

Erections also require nerve entrapment to divert blood flow to the corporation’s cornea. Psychogenic erections secondary to sexual images or auditory stimuli transmit sensory information to the spinal cord from T-11 to L-2. Nerve impulses flow into the vascular bed of the pelvis, diverting blood flow to the corpora cavernosa. Reflex erections secondary to tactile stimulation of the penis or genital area trigger reflex arch with sacred roots in S2 to S4. Nocturnal erections occur during sleep with rapid eye movements (REM) and occur 3 to 4 times during the night. Depressed men rarely experience REM sleep and therefore do not have an erection at night or early in the morning.

Diabetic Pathology ED
The natural history of erectile dysfunction in people with diabetes is usually progressive and does not occur overnight. Vascular and neurological mechanisms are more frequently involved in people with diabetes. Atherosclerosis in the penile and penile arteries restricts the flow of blood to the cavernous cavern. Due to loss of alignment in the cavernous trabeculae, venous flow is also lost. This loss of flow results in the inability of the trunk cavernose to expand and compress the outboard vessels.

Autonomic neuropathy is an important contributor to the high incidence of erectile dysfunction in people with diabetes. Positive fibers of norepinephrine and acetylcholine in cavernous bodies have also been shown to decrease in people with diabetes. This results in the loss of autonomic nerve-mediated muscle relaxation necessary for erection.

evaluation
The first step in assessing erectile dysfunction is a thorough sexual history and physical examination. History can help distinguish the underlying causes from the psychogenic causes. It is important to investigate the onset, progression, and duration of the problem. If a man has a history of “no sexual problems until one night”, it is likely that the problem is related to work anxiety, discouragement, or emotional distress. Apart from these reasons, only radical prostatectomy or any other obvious trauma to the genital tract causes sudden loss of sexual function in men.

Unsupported skipping post-penetration erection is usually caused by anxiety or vascular steel syndrome. In vascular steel syndrome, blood is diverted from the affected cavernous bodies to meet the oxygen needs of the thrust basin. Questions should be asked about the presence or absence of night or morning erections and the possibility of masturbation. Complete loss of nighttime erections and the possibility of masturbation are signs of neurological or vascular disease. It is important to remember that sexual desire is not lost with erectile dysfunction, only the ability to act on these emo

(vascular abnormalities),

(vascular abnormalities), visual field abnormalities (prolactinoma or pituitary mass), breast examination (hyperprolactinaemia), penile stenosis (pyronia disease), testicular atrophy (testosterone deficiency) and asymmetry or asymmetry. A rectal examination allows you to assess the tone of the prostate and the sphincter, abnormalities associated with autonomic dysfunction. Holy and perineal neurological examination will help to assess autonomic function.

Treatment

Initially, preventive measures will help reduce the risk of developing erectile dysfunction. Improved glycemic control and hypertension, smoking cessation and reduction of excessive alcohol consumption have been shown to be beneficial for patients with erectile dysfunction. It is also useful to avoid or replace medications that may contribute to erectile dysfunction.

Once ED develops, oral agents are considered first-line treatment.

Sildenafil (Viagra) works by blocking cGMP catabolism, causing an increase in nitric oxide. 56% of diabetic men with erectile dysfunction experience improvement with sildenafil, compared to about 70% of men who are not with erectile dysfunction diabetes.

Sildenafil should be taken 1 to 2 hours before intercourse. It is important to tell patients that the effectiveness of the drug requires sexual stimulation. A patient at our clinic has recently complained of no effect on taking sildenafil. It was later discovered that he had taken the pill and then sat on his couch reading a book on how to grow tomatoes!

The starting dose of sildenafil is 50 mg, and the dose may be increased to 100 mg. (The tablets can be split in half with a tablet cutter). Each pill costs between $ 8 and $ 10 and patients can easily buy the best price online.

Side effects of sildenafil are similar to taking niacin or any vasodilator, including headache, dizziness, mild noise and warm eyelashes. Some people experience a bluish tinge in the cornea, which makes them feel as if they are wearing light blue sunglasses. This effect can take several hours. Syncope and myocardial infarction, the most serious side effects, have been reported in men who also take nitrates for coronary artery disease. Sildenafil also has side effects in people with hypertrophic cardiomyopathy, as decreasing overload and after cardiac output can increase flow obstruction, resulting in an unstable hemodynamic condition.

Sildenafil is strongly contraindicated in men taking nitrates. Other men whose use involves potential risks include:

with active coronary ischemia (eg positive exercise tolerance test) that do not take nitrates

with congestive heart failure (CHF) and low blood pressure or low volume states

with a complicated multi-drug antihypertensive regimen

use of drugs that extend the half-life of sildenafil by blocking CYP3A4

Another oral treatment that has been used with little success is yohimbine (Chocon, Johimeks). It is an alpha 2 adrenergic receptor blocker that increases the cholinergic effect and reduces the adrenergic tone. It stimulates the average brain and increases libido. Optimal results appear when used in men with psychogenic erectile dysfunction. Side effects include anxiety and insomnia.

For patients who are not candidates for oral therapy, intravenous injections are an acceptable alternative. Injections of alprostadil (Caverject) and papaverine (Genabid) are used to induce erection.

This form of therapy has a response rate of over 70%. The sympathetic nervous system usually keeps the penis in a flaccid or unrecognized state. All vasoactive drugs, when injected into a bucket of cobweb, inhibit or cancel sympathetic inhibition to stimulate smooth muscle trabeculae relaxation. A flood of blood floods the sinusoidal bodies of the corpora cavernosa of the penis and creates an erection.

Patients using this treatment should be trained by a urologist and a sterile technique should be used. Medicines should be injected into the penis shaft and into one of the erectile bodies of the penis (cavernous body) 10 to 15 minutes before intercourse. Most patients do not complain of pain during the injection. No st

It stimulates the enlargement of the arterial inlet and the occlusive tension rings discourage venous flow from the cavernous body of the penis. The penis placed inside the cylinder, a pump is used to produce a vacuum which pushes blood towards the penis …. After the tensile ring slides over the base of the penis, the cylinder is deleted Erection lasts until the rings are removed. The one-time expense of this therapy is $120–300.

insert and does not present postoperative mechanical problems. The inflatable prosthesis has a pump that is placed in the testicle bag to inflate and devalue on request. Future versions will have a remote control device similar to a garage-door opener.

The main complication of a surgical implant is postoperative infection, which occurs in about 8% of cases of diabetes. This infection can be difficult to treat and may require removal of the device, even if it does. <3% of the time. The infection can also cause penile erosion, reduced penile sensation, and auto-inflation. Glycemic control should be optimized several weeks before surgery. Once a patient has surgery, none of the oral agents or vacuum devices will work because of the destroyed penile architecture.

Testosterone therapy with injections or patches should be tried in patients with documented low testosterone levels. Testosterone deficiency is a rare cause of impotence but should always be ruled out with a serum value.

Psychotherapy should be offered to the patients and their partners to address any interpersonal conflicts, because ED is a problem for couples—not just men.

 

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