While diabetes is one of the main causes of erectile dysfunction, the support of these intimate problems remain insufficiently taken into account. Yet this neglect can have important consequences on the overall quality of life of the patient. Dr. Pierre Desvaux, Andrologist and sexologist, tells us more.
Doctissimo: What are the links between diabetes and erection disorders?
Dr. Pierre Desvaux: Diabetes can cause vascular, nerve, and hormonal violations. But the main cause of erectile tissue and metabolic. In diabetic patients, the corpora cavernosa tend to less release of nitric oxide originally of tissue release, necessary step for these tissues fill with blood and enable an erection. Moreover, quality even of these tissues is less important for poorly controlled blood sugar.Finally, diabetic patients (especially after 50 years) are more likely to have below normal testosterone levels. Hypogonadism can result in libido and erectile disorders.
Doctissimo: What are the consequences of these intimate problems in the treatment of diabetes?
Dr. Pierre Desvaux: A study of an American urologist, Dr. Benjamin H Lowentritt, showed in 2004 that erectile dysfunction can lead to a less good monitoring of the treatment of a chronic disease. This is true for diabetes but also for hypertension, depression, cholesterol… The diabetic patient think that treatment is at the origin of these erectile dysfunction and will therefore abandon, while there is no link between the molecule and these intimate problems.
It is therefore particularly important to take into account this disorder intimate to improve investment of patients to their diabetes support and respect for the lifestyle-diet rules, which are also determinant of prevention of these disorders.
Doctissimo: Must diabetes support include an examination on these intimate problems?
Dr. Pierre Desvaux: It is more than desirable on the one hand, we saw, to ensure proper follow-up of the treatment of this chronic disease but also because these disorders may prefigure of other more serious vascular disease. Schematically, the mechanisms at work at the level of the corpora cavernosa is substantially the same for the other arteries of the body. If there are cardiovascular risk factors (diabetes is one) and there is the presence of erectile disorder, must then be careful the cardiovascular risk of the patient. This does not mean that all diabetics who have erectile dysfunction will have cardiac problems, fortunately… But prevention is better.
Doctissimo: What is the support of these disorders in diabetic patients?
Dr. Pierre Desvaux: The diabetic patient can sometimes be psychologically affected by his illness, it may be in breach of treatment, not to follow his diet… Support erectile dysfunction can be a means to again make his support actor. I so often say to my patients: “I want to help you for these disorders but he also going to help me a little trying to balance this diabetes”.
Doctissimo: Specifically, what is supported?
Dr. Pierre Desvaux: It is based on the facilitators of erection, the IPDE-5. There are now three different molecules (tadalafil, vardenafil and sildenafil) which give all good results. These results are even more satisfactory that testosterone is normalized (support may be necessary for hypogonadism), blood glucose is balanced and that the conditions are met. The limitation period may be adapted to the wishes of the patient and the results obtained.
In the event of failures of these drugs, intracaverneuses injections can also be an alternative, even if we understand easily that they appear less “attractive”. Moreover, let us not forget that the diabetic is above all a human. By this, I mean that the cause of these disorders can be diabetes but not necessarily…
Doctissimo: Are the diabetologists sensitized to these intimate problems?
Dr. Pierre Desvaux: The diabetologists pose increasingly question their patients. They can if any, prescribing appropriate drugs themselves or send their patients to a specialist if they do not feel comfortable with this support or if the first prescription did not give good results.
Continuous personal development (which the obligation has recently underlined by the law HPST), Andrologist and sexologists are particularly dynamic. The recent creation of the professional national Council of Sexology including promoted development of modules of continuous training of general practitioners and/or specialists.