Wd. Dunsmuir et Sav. Holmes, THE ETIOLOGY AND MANAGEMENT OF ERECTILE, EJACULATORY, AND FERTILITY PROBLEMS IN MEN WITH DIABETES-MELLITUS, Diabetic medicine, 13(8), 1996, pp. 700-708
Citations number
95
Categorie Soggetti
Endocrynology & Metabolism","Medicine, General & Internal
Erectile impotence is more common in the diabetic than the general pop
ulation, occurs at a younger age, and is often associated with ejacula
tory problems. For these, and possibly for other more subtle reasons,
fertility may be a problem for men with diabetes. The symptoms of erec
tile and ejaculatory dysfunction are frequently not discussed between
patient and doctor. Psychological factors are important but the vast m
ajority of diabetic patients have an organic basis for their impotence
. Both neurogenic and vascular factors are important in the pathogenes
is of erectile failure. Autonomic neuropathy is almost certainly the c
ause of the ejaculatory failure that may be present in up to 40% of me
n with diabetes. The final biochemical mediator of erection within the
penile erectile tissue is nitric oxide and a key enzyme in its degrad
ation is phosphodiesterase (type V). Drugs that affect the metabolism
of this enzyme are being developed to treat erectile failure. At prese
nt, the self injection of intra-cavernosal erectogenic agents (such as
prostaglandin E1) provide the main form of therapy for erectile failu
re. Vacuum devices are a simple alternative and venous ligation surger
y may be effective for a properly selected cohort of patients. Prosthe
tic implants are a final option for patients in whom all else has fail
ed. Fertility problems, particularly when associated with ejaculatory
failure can be overcome with modern assisted reproductive techniques.
Nowadays, these will frequently involve gamete micro-manipulation.