Diabetes and male sexual function (Part 5)
The clinical affect of DM on penile blood flow has been well documented. Patients with insulin-dependent diabetes and associated coronary artery disease have significantly more severe disease related to the cavernosal artery than noninsulin-dependent diabetic patients. Benvenuti et al proposed that, in diabetic ED, vascular obstruction is a more important factor than nerve damage. The main complication of buy diabetes drugs is atherosclerosis. Increased activation of protein kinase C, overexpression of endothelin and angiotensin II, increased synthesis of diacylglycerol, oxidative stress and increased production of plasminogen activator inhibitors are considered to promote vascular pathology in diabetic patients with ED.
DM is often associated with other ED risk factors such as hypertension, dyslipidemia and smoking. In patients with these additional factors, the incidence of ED increases. Also, up to 30% of diabetic men will have psychogenic factors that further compound their diagnosis.
The relative importance of these cofactors varies among individuals. ED, when caused by DM, tends to be more severe than with other etiologies.
The clinical assessment and management of diabetic men with ED are similar to those used for other causes of ED. It must not be forgetten, however, that ED may be the presenting symptom of undiagnosed diabetes. Furthermore, poorly controlled DM exacerbates ED, and the primary goal of treatment is to avoid hyperglycemia.