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Sexual dysfunction among men with diabetes: A review

Authors:

N. L. De Silva ,

General Sir John Kotelalwala Defence University, LK
About N. L.
Department of Clinical Sciences, Faculty of Medicine
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R. E. Wickramarachchi,

General Sir John Kotelalwala Defence University, LK
About R. E.
Department of Clinical Sciences, Faculty of Medicine
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M. Sumanatilleke,

National Hospital of Sri Lanka, LK
About M.
Diabetes and Endocrinology Unit
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N. Somasundaram

Diabetes and Hormone Centre, Colombo, LK
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Abstract

Male sexual dysfunction (SD) includes erectile dysfunction (ED), ejaculatory disorders and hypoactive sexual desire disorder (HSDD).

 

Erectile dysfunction is extremely common in diabetes and has a psychosocial and relationship impact on the individual, yet remains neglected in clinical practice. Factors that cause erectile dysfunction include, vasculopathy, neuropathy, insulin resistance, visceral adiposity, hypogonadism, endothelial dysfunction, and mental health issues. Erectile dysfunction is considered a predictor of underlying silent cardiovascular disease, thus providing a window of opportunity for risk reduction. Treating individuals with ED starts with patient and partner education, aggressive risk factor modification, lifestyle interventions, medication adjustment and psychosexual counselling. Phosphodiesterase-5 inhibitors (PDESi) are effective in a significant proportion of men though the response is less attractive compared to those without diabetes. Vacuum erection devices, intraurethral/ topical alprostadil are alternatives for men with contraindications or poor response to PDESi. Intracavernosal vasoactive agents and Low-intensity shockwave therapy may be attempted in some men. Among men with diabetes, refractory ED is frequent and would benefit from penile prostheses.

 

Out of the common ejaculatory disorders among men, premature ejaculation, delayed ejaculation/ anejaculation and retrograde ejaculation have been shown to be associated with diabetes. Indeed, there is a robust organic link between autonomic neuropathy and retrograde ejaculation. While premature ejaculation has several treatment options that include pharmacotherapy (selective serotonin reuptake inhibitors and local anaesthetics) and psychosexual counselling, options for delayed ejaculation/ anejaculation and retrograde ejaculation are limited except for medication adjustment. Among men with diabetes who have HSDD, attempts should be made to unravel treatable underlying causes such as hypogonadism and depression; optimising medical management, psychosexual counselling and medication adjustment would also be beneficial.

How to Cite: De Silva, N.L., Wickramarachchi, R.E., Sumanatilleke, M. and Somasundaram, N., 2022. Sexual dysfunction among men with diabetes: A review. Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 13(2), pp.53–64. DOI: http://doi.org/10.4038/sjdem.v13i2.7479
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Published on 08 Dec 2022.
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