Skip to main content

Advertisement

SpringerLink
Log in

Etiology and treatment of erectile failure in diabetes mellitus

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Men with diabetes are especially prone to neuronal and endothelial disease and are afflicted with erectile dysfunction (ED) at a much higher incidence and prevalence than normal men, with a consequent reduction in quality of life. ED in diabetes results from combinations of impairments from nearly every step in the production of a penile erection. These include the failed transmission of neural signals to and from the spinal cord due to neuropathy resulting in reduced neural nitric oxide (NO) delivery to cavernosal smooth muscle, impaired sinusoidal endothelial cell NO release because of endothelial dysfunction, reduced arterial and arteriolar inflow due to peripheral vascular disease, and failure of relaxation of the corpora from glycation of the elastic fibers. The evaluation of men with diabetes and ED is similar to that in nondiabetic men. It includes assessment of gonadal, neural, arterial, and on occasion, venous function, along with marital and psychological status. Although treatment options for diabetic men with ED have fortunately expanded, the risk factors for ED are the same as those for cardiovascular disease; a flagging penis should raise a red flag of warning to evaluate and treat the risk factors for coronary, cerebral, and peripheral vascular disease, which are common in persons, of either sex, afflicted by diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Feldman HA, Goldstein I, Hatzichristou DG: Impotence and its medical and psychological correlates: results of the Massachusetts Aging Male Study. J Urol 1994, 151:54–61.

    PubMed  CAS  Google Scholar 

  2. Kaiser FE: Erectile dysfunction in the aging man. Med Clin North Am 1999, 83:1267–1278.

    Article  PubMed  CAS  Google Scholar 

  3. Marin R, Escrig A, Abreu P, Mas M: Androgen-dependent nitric oxide release correlates with constitutive NOS isoenzymes. Biol Reprod 1999, 61:1012–1016. Offers a satisfactory reason for the connection between androgen secretion and erection.

    Article  PubMed  CAS  Google Scholar 

  4. Bohlen H, Nase G: Obesity lowers hyperglycemic threshold for impaired in vivo endothelial nitric oxide function. Am J Physiol Heart Circ Physiol 2002, 283:H391-H397.

    PubMed  CAS  Google Scholar 

  5. Sullivan ME, Thompson CS, Dashwood MR, et al.: Nitric oxide and penile erection: is erectile dysfunction another manifestation of vascular disease? Cardiovasc Res 1999 15;43:658–665. Connects cardiovascular risk to ED via the common pathway of endothelial disease with impaired NO release.

    Article  PubMed  CAS  Google Scholar 

  6. Schachter M: Erectile dysfunction and lipid disorders. Curr Med Res Opin 2000, 16:S9-S12.

    Article  PubMed  Google Scholar 

  7. De Angelis L, Marfella MA, Siniscalchi M, et al.: Erectile and endothelial dysfunction in type II diabetes: a possible link. Diabetologia 2001, 44:1155–1156.

    Article  PubMed  Google Scholar 

  8. Colberg SR, Stansberry KB, McNitt PM, Vinik AI: Chronic exercise is associated with enhanced cutaneous blood flow in type 2 diabetes. J Diabetes Complications 2002, 16:139–145.

    Article  PubMed  Google Scholar 

  9. Plante GE: Vascular response to stress in health and disease. Metabolism 2002, 51:25–30.

    Article  PubMed  CAS  Google Scholar 

  10. Xie Y, Garban H, Ng C, et al.: Effect of long-term passive smoking on erectile function and penile nitric oxide synthase in the rat. J Urol 1997, 157:1121–1126.

    Article  PubMed  CAS  Google Scholar 

  11. Seftel AD, Vaziri ND, Ni Z, et al.: Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology 1997, 50:1016–1022.

    Article  PubMed  CAS  Google Scholar 

  12. Jiaan DB, Seftel AD, Fogarty J, et al.: Age-related increase in an advanced glycation end product in penile tissue. World J Urol 1995, 13:369–375.

    Article  PubMed  CAS  Google Scholar 

  13. Burchardt T, Burchardt M, Karden J, et al.: Reduction of endothelial and smooth muscle density in the corpora cavernosa of the streptozotocin induced diabetic rat. J Urol 2000, 164:1807–1811.

    Article  PubMed  CAS  Google Scholar 

  14. Bagatell CJ, Heiman JR, Rivier JE, Bremner WJ: Effects of endogenous testosterone and estradiol on sexual behavior in normal young men. J Clin Endocrinol Metab 1994, 78:711–716.

    Article  PubMed  CAS  Google Scholar 

  15. Guay AT, Bansal S, Heatly GJ: Effect of raising endogenous testosterone levels in impotent men with secondary hypogonadism: double blind placebo-controlled trial with clomiphene citrate. J Clin Endocrinol Metab 1995, 80:3546–3552.

    Article  PubMed  CAS  Google Scholar 

  16. Rosen RC, Riley A, Wagner G, et al.: The International Index of Erectile Function (IIEF): a multidimensional scale for the assessment of erectile dysfunction. Urology 1995, 46:697–706.

    Article  Google Scholar 

  17. Shabisgh R, Klein LT, Seidman S: Increased incidence of depressive symptoms in men with ED. Urology 1998, 52:848–853.

    Article  Google Scholar 

  18. Rowland DL, Greenleaf W, Mas M, et al.: Penile and finger sensory thresholds in young, aging, and diabetic males. Arch Sex Behav 1989, 18:1–12.

    Article  PubMed  CAS  Google Scholar 

  19. Gaskell P: The importance of penile blood pressure in cases of impotence. Can Med Assoc J 1971, 105:1047–1051.

    PubMed  CAS  Google Scholar 

  20. Lue TF, Hricak H, Marich KW, Tanagho EA: Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology 1985, 155:777–781.

    PubMed  CAS  Google Scholar 

  21. Tam SW, Worcel M, Wyllie M: Yohimbine: a clinical review. Pharmacol Ther 2001, 91:215–243.

    Article  PubMed  CAS  Google Scholar 

  22. Goldstein I, Lue TF, Padma-Nathan H, et al.: Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998, 338:1397–1404.

    Article  PubMed  CAS  Google Scholar 

  23. Boulton AJ, Selam JL, Sweeney M, Ziegler D: Sildenafil citrate for the treatment of erectile dysfunction in men with type II diabetes mellitus. Diabetologia 2001, 44:1296–1301. Useful summary of what can be expected for sildenafil in diabetic men.

    Article  PubMed  CAS  Google Scholar 

  24. Cheitlin MD, Hutter AM, Brindis RG, et al.: Use of sildenafil in patients with cardiovascular disease. J Am Coll Cardiol 1999, 99:168–177.

    CAS  Google Scholar 

  25. Muller JE, Mittleman A, Maclure MA, et al.: Triggering myocardial infarction by sexual activity. JAMA 1996, 275:1405–1409.

    Article  PubMed  CAS  Google Scholar 

  26. Herrman H, Chang G, Klugherz B, Mahoney P: Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Eng J Med 2000, 342:1622–1626.

    Article  Google Scholar 

  27. Varden E, Cartledge J: Tadalafil (Cialis) for men with erectile dysfunction. Int J Clin Pract 2002, 56:300–304.

    Google Scholar 

  28. Pryor J: Vardenafil: update on clinical experience. Int J Impot Res 2002, 14 (suppl 1):S65-S69.

    Article  PubMed  Google Scholar 

  29. Morley JE, Perry HM 3rd: Androgen deficiency in aging men. Med Clin North Am 1999, 83:1279–1289.

    Article  PubMed  CAS  Google Scholar 

  30. Lue TF: Erectile dysfunction. N Engl J Med 2000, 342:1802–1181. Overview of physiology, pathophysiology, and treatments other than surgical for ED.

    Article  PubMed  CAS  Google Scholar 

  31. Padma-Nathan H, Hellstrom WJG, Kaiser F, et al.: Treatment of men with erectile dysfunction with transurethral alprostadil. N Eng J Med 1997, 336:1–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Eastern Virginia Medical School, The Leonard R. Strelitz Diabetes Institutes, 855 W. Brambleton Avenue, 23510, Norfolk, VA, USA

    Donald Richardson MD & Aaron Vinik MD, PhD

Authors
  1. Donald Richardson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron Vinik MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Richardson, D., Vinik, A. Etiology and treatment of erectile failure in diabetes mellitus. Curr Diab Rep 2, 501–509 (2002). https://doi.org/10.1007/s11892-002-0120-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-002-0120-4

Keywords

Search

Navigation