At the basis of the disorder there may be multiple factors that are often associated with alteration of the nerves and/or vascular structures
I am 50 years old, have been diabetic for 13 and on metformin treatment. I’m starting to have problems in sexual intercourse because I have a very weak and fleeting erection. Is it true that there is a link between diabetes and impotence? Is there any treatment that can help me? I’ve read that glycemic control can influence the problem: should I talk to the diabetes specialist? Are specific investigations necessary to understand the cause?
He answers Valeria MontaniHead of Diabetology, Atri Hospital (TE), Association of Diabetologists (GO TO THE FORUM)
Il erectile deficitdefined as the constant inability to achieve and/or maintain an erection adequate to carry out satisfactory sexual intercourse, a multifactorial condition in which Diabetes is one of the most commonly involved organic causes and is closely linked to age, the duration of the disease, blood sugar control, the degree of obesity and the possible presence of micro- and macro-vascular complications. This disturbance, in order to assume the characteristics of a pathology, must not be limited to an occasional occurrence, however possible even in non-diabetic persons. At the basis of an erection deficit there may be multiple factors, even concomitant ones, which are often associated with changes in nerves (neuropathy) and/or vascular structures (atherosclerosis)with reduced blood flow into the cavernous bodies responsible for the erectile phenomenon.
it is also necessary to carry out some hormone tests (blood dosage of testosterone, free testosterone, cortisol, Fsh or follicle-stimulating hormone, Lh or luteinizing hormone, Psa or prostate specific antigen, and prolactin) which allow to exclude other responsible causes. In fact too low levels of testosterone in the blood lead to a decrease in sexual desire and the ability to get an erection. The different causes that can determine the onset of erectile dysfunction are divided into psychogene (anxiety and depression), endocrine (hypogonadism or decreased testosterone), neurogenic (multiple sclerosis, Parkinson’s disease, trauma), vascular (diabetes, hypertension, atherosclerosis), pharmacological (antihypertensives, psychopharmaceuticals, hormonal therapies), surgery and radiotherapy. it should be emphasized that an erectile deficit is a warning sign for future cardiovascular events. Therefore in a diabetic patient with this problem it is advisable to carry out screening for cardiovascular disease.
The dysfunction is, in most cases, reversible given that the more frequent and more severe the hyperglycemia is, the greater and longer it is prolonged. For this important keep glycemic values under control and follow a correct lifestyle, avoiding smoking and alcohol abuse. As far as therapy is concerned, there are drugs, such as sildenafil, vardenafil, avanafil and tadalafil, which inhibit an enzyme (phosphodiesterase 5) involved in the response mechanisms to sexual stimulation. The inhibition of this enzyme allows erection in case of deficiency of vasodilator substances such as nitric oxide, deficient in diabetics. The action of these drugs occurs only in the presence of a sexual stimulus, so that the effect of the therapy is more natural. I therefore advise you to consult your diabetologist who will prescribe the necessary tests and, once the origin of your problem has been identified, will suggest how to manage it and, if necessary, which drugs to use among those we have available today.
December 7, 2022 (change December 7, 2022 | 15:41)
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