Sexual Dysfunction in Males with Diabetes

Before we analyze the various causes of sexual dysfunction in diabetic patients, we must have a basic idea of the normal physiology, anatomy, neurology, and vascular mechanisms that contribute to penile erection. Penis comprises mainly two muscles, a corpus cavernosa and the corpus spongiosum. The cavernosum smooth muscles of the arteriola and arterial walls play a key role in the erectile process. In flaccid state, these smooth muscles are tonically contracted allowing only a small amount of arterial flow. 

Sexual stimulation triggers the release of neurotransmitters from the cavernous nerve terminal which results in the relaxation of these smooth muscles. Erection begins with sensory and mental stimulation. During sexual arousal, love messages simulate the penis, impressions from the brain and local nerves cause the muscles of corpus cavernosa to relax allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpus cavernosa making the penis to expand and creating an erection. The tunica albuginea which is a membrane surrounding the corpus cavernosa muscle helps to trap the blood in the muscle-sustaining the erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening the outflow channel. 

How does ejaculation occur?

Ejaculation is the reflex action controlled by the central nervous system. It is triggered when a sexual act reaches a critical level of excitement. It has 2 phases. In the first phase, the vas deferens, which are the tubes that store and transport the sperm from the testes, contract to squeeze the sperm out towards the base of the penis. The prostate gland and seminal vesicles release secretions to make semen. In the second phase, muscles at the base of the penis contract every .8 seconds and force the semen out of the penis.

How does Diabetes cause Erectile Dysfunction?

The connection between diabetes and erectile dysfunction is related to your circulation and nervous system. Poor control of blood sugar levels can damage small blood vessels and nerves. Damage to the nerves that control sexual stimulation and response can impede a man’s ability to achieve an erection firm enough to have sexual intercourse. Reduced blood flow from damaged blood vessels can also contribute to erectile dysfunction. When a man becomes sexually aroused, a chemical called nitric oxide is released into his bloodstream. Nitric oxide tells arteries in the muscles in the penis to relax. It allows more blood to flow into the penis and thereby attains an erection. When blood sugar levels get too high, less nitric oxide is produced. Other causes of erectile dysfunction include obesity, hypertension, high cholesterol levels, low testosterone levels, stress, anxiety and depression, smoking, excess alcohol intake, also as a side effect for certain medications taken for hypertension and depression, damage or injury to the spinal cord, etc.

What are the common tests done to diagnose erectile dysfunction?

Apart from routine tests like blood sugar, lipid profile levels, hormone studies which include testosterone and other hormones, nervous system tests such as blood pressure and sweat test which can roll out nerve damage to the heart, blood vessels, and sweat glands. A physical examination to assess the genitals and nerve reflexes in the legs and penis. A detailed patient history and drug history, injection of a drug into the penis to check that the blood supplied to the penis is normal etc. A penile doppler flow study is also very essential. 

Treatment for Erectile Dysfunction

Treatment for Erectile Dysfunction will depend on the cause and there is a range of good treatment options. First and foremost is good control of diabetes, hypertension hyperthyroidism, etc. The most common treatment for Erectile Dysfunction is with oral tablets. These have shown to work well in many men with diabetes in restoring sexual functions. The commonest used drugs are PDE5 inhibitors. The most commonly used among these are sildenafil, tadalafil, vardenafil, and avanafil. These drugs cause an erection by increasing blood flow to the penis. There are several other forms of treatment for Erectile Dysfunction. And these include hormone therapy where there is testosterone replacement therapy which is the commonest, then there is penile injection therapy by injection of alprostadil directly into the penis is another option. This hormone injection increases blood flow to the penis. Vacuum pump therapy is another mode of treatment in erectile dysfunction. A plastic tube connected to the pump is placed over the penis. The pump empties the air out of the tube and causes blood to be drawn into the penis. A ring is placed on the base of the penis to maintain erection. 

Penile prosthesis are usually considered when all other treatment options have failed as it requires a surgical procedure. An inflatable rod is implanted into the penis to make it erect for intercourse. A good psychological counselling and support may help patients in whom erectile dysfunction is due to anxiety, depression, etc. Lifestyle changes like a healthy diet and regular exercises significantly improved erectile dysfunction. Weight loss can improve erectile dysfunction and sexual desire in men with diabetes. Losing weight significantly increased testosterone levels and thereby improved erectile dysfunction. Supplementation of amino acids like L-arginine and L-citrulline has improved erectile dysfunction by increasing the body’s production of nitric oxide levels.