Diabetes And Erectile Dysfunction

The ability to get an adequate erection depends upon adequate blood flow to the penis and intact nerve function. Men with diabetes whose nerves to the penis are damaged and/or whose blood supply to the penis is reduced may not be able to get a strong erection. Before blaming nerve damage and blood supply problems for erectile dysfunction, however, it is important to exclude other causes such as low testosterone levels, medicines (for blood pressure and depression), alcohol, and cannabis (marijuana). Psychological issues such as depression, job stress, and other relationship problems may also contribute to erectile dysfunction.

There are a number of treatment options for erectile dysfunction:

• PDE5 enzyme inhibitors. Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are the medicines prescribed for erectile dysfunction. These medicines block an enzyme (called cyclic GMP-specific phosphodiesterase type 5), prolonging the blood flow into the penis and so improving the ability to get an erection. When taking these medicines, you do have to be sexually aroused to get an erection. The recommended dose of sildenafil for most patients is one 50-mg tablet taken approximately one hour before sexual activity. The peak effect is at one and a half to two hours, with some effect persisting for four hours. In clinical studies, people with diabetes mellitus using sildenafil reported 50 to 60 percent improvement in erectile function. The recommended doses of both vardenafil and tadalafil are 5 to 20 mg. Tadalafil has been shown to improve erectile function for up to thirty-six hours after dosing. In clinical trials of these medicines, only a few adverse effects were reported—transient mild headache, flushing, dyspepsia, and some altered color vision. If an erection lasts longer than four hours (called priapism), you should go to the emergency room. These medicines should not be used if you are taking nitrates for heart disease, because that would cause a severe drop in blood pressure. You should also seek medical advice before taking these medicines if you have heart disease or have had a heart attack, stroke, or a life-threatening heart rhythm problem. Rarely, a decrease in vision or permanent visual loss has been reported after using these drugs.

• Alprostadil, papaverine, and papaverine with phentolamine. If the

PDE5 inhibitors do not work well, then you can try a medicine called alprostadil, which used to be given by injections, but now is available as a urethral suppository (brand name Muse). It is a tiny pellet that is inserted into the urethra, and it can be quite effective at producing an erection. If this, too, is not successful, then injections into the penis can be tried: the drugs most commonly used include papaverine injection, papaverine with phentolamine injection, and alprostadil (prostaglandin E1) injection. The injections sound unpleasant but are not that painful. It is important to get careful instructions from your doctor to prevent injury and priapism.

• External vacuum therapy (Erec-Aid System). This consists of a suction chamber operated by a hand pump that creates a vacuum around the penis. This draws blood into the penis to produce an erection, which is maintained by a specially designed tension ring inserted around the base of the penis that can be kept in place for up to twenty to thirty minutes. While this method is generally effective, it does require psychological support from the partner.

• If all the treatments described above fail, then surgical implants are available, but rarely needed.

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