Lee Chung Horn
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DIABETES AND SEX

Erectile dysfunction, often referred to as impotence, is the persistent inability to achieve and maintain an erection sufficient to complete sexual intercourse. At some time or another, most men experience erection problems, but for some, impotence is a chronic problem. As many as 10% of the male population and 35% of men over 60 may have erectile dysfunction. As many as 40 to 50% of men with diabetes may develop ED.

How Erection Occurs

Erection occurs when blood is pumped into the penis. The more blood that fills the penis, the firmer the erection. Failure to achieve erection results when the penis does not fill or empty appropriately.

The penis has two chambers called the corpora cavernosa. These chambers run the length of the penis and are filled with a spongy tissue which contains smooth muscles, fibrous tissues, spaces, veins and arteries. The corpora cavernosa are surrounded by a membrane called the tunica albuginea. The urethra, which is the pathway for both urine and semen, runs along the underside of the corpora cavernosa.

Erection begins when a man receives sensory and mental stimulation. Impulses from the brain and nerves around the penis cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. This blood creates pressure in the corpora cavernosa, which makes the penis expand. By helping to trap the blood in the corpora cavernosa, the tunica albuginea sustains the erection. Erection is reversed when the muscles in the penis contract, stopping the blood from flowing in and opening the channels that allow the blood to flow out.

There are different levels of erectile dysfunction:

               A total inability to achieve erection

               An irregular ability to achieve erection

               Brief erections -- an inability to maintain erections  

ED is a treatable problem.

What Causes Erectile Dysfunction?

Although psychological problems may have a big part to play in creating ED, there are often physical causes too. These include

               Diabetes Mellitus

               Blood Vessel (Vascular) Disease

               Venous Leak

               Neurologic Causes

               Medication pills for high blood pressure, heart medications, antidepressants, tranquilizers and sedatives

               Hormonal Imbalances

               Peyronie's Disease

               Pelvic Area Surgery  

Speak with your endocrinologist. Do not be embarrassed. A number of tests may be performed to help your doctor come to a diagnosis. These may include blood and urine tests, urinalysis, testosterone and prolactin, liver and kidney function, glucose, lipid profile, thyroid function test, and other specialised tests.

Treatments for ED

               Motivation: Men need to evaluate honestly what is motivating them and to understand their expectations about treatment. Unrealistic expectations can sabotage the success of any treatment method. Patients also have to be committed to the treatment option they select, and be sure that they are willing to do what is necessary to make the chosen course of treatment successful.

               Willingness to Adapt: All impotence treatments require active participation by the patient. Men have to be willing to learn new techniques and adapt for impotence treatment to succeed.

               Partner's Attitude: Impotence has rightly been called a couple's problem, for a variety of reasons. For instance, some treatments may require a man's partner to administer a medication. And since partners often experience similar emotional responses to impotence, some couples find that counseling can help them reestablish a mutually satisfying sexual relationship. Either way, a partner's involvement in and commitment to treatment definitely supports a man's recovery. In fact, most partners of men with erectile dysfunction want to be involved in the treatment process.

Hormone Replacement Therapy

Hormone replacement therapy can be used to treat men with hormone deficiencies. Testosterone treatment is not appropriate for men who have been diagnosed with prostate cancer, and is usually not necessary after bladder surgery because testosterone levels are normal.

Oral Medications

There are several different treatments for impotence which involve taking a prescription medication orally (through the mouth, usually as a pill). Each of these treatments has advantages and disadvantages. In general, the main advantages of oral medications are that they are easy to self-adminster, and require no surgical procedures. These include Viagra, Cialis and Levitra. These drugs can be safely used but only with a doctor's advice.

Penile Implants

Another treatment option is the penile prosthesis, a device that is surgically implanted inside the body. Implants are most successful for men who can ejaculate and have orgasms even though they can't achieve erections.

Vascular Reconstructive Surgery

A very small percentage of men may be candidates for some kind of reconstructive surgery to improve penile blood flow, including revascularization and venous ligation. Vascular reconstructive surgery is a technical and relatively expensive procedure.


 

Copyright of Lee Chung Horn Diabetes & Endocrinology 2009