Erectile Dysfunction
GENERAL PRINCIPLES
Epidemiology
It is estimated that 40%-60% of men with diabetes have erectile dysfunction (ED), and the prevalence varies depending on the age of the patient and duration of diabetes.
In addition to increasing age, ED is associated with smoking, poor glycemic control, low high-density lipoprotein, neuropathy, and retinopathy.Etiology
ED can result from nerve damage, impaired blood flow (vascular insufficiency), adverse drug effects, low testosterone, psychological factors, or a combination of these etiologies.
DIAGNOSIS
Evaluation should include assessment for hypogonadism (see Chapter 24 Endocrinology).
TREATMENT
If testosterone is low, and both PSA and prostate examination are normal, then testosterone replacement may be beneficial, and a trial of phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil) is often warranted. Macular edema should be ruled out before starting these agents.