Diabetes mellitus, erectile dysfunction

Unlabeled Uses Treatment of pralidoxime-induced hypertension, arrhythmias, asthma, bladder instability, cardiac diseases, diabetes mellitus, erectile dysfunction, extravasation (dopamine and epinephrine), hyperhidrosis, myocardial infarction, Raynaud s phenomenon, surgery, sympathetic pain... 

Snow KJ. Erectile dysfunction in patients with diabetes mellitus advances in treatment with phosphodiesterase Type 5 inhibitors. BrJ Diab Vase Dis 2002 2 282-287. 

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39% in those of 40 years. Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14%). While the evidence is not conclusive, drug therapy is thought to underlie 25% of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H -receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly adrenoceptor blockers and thiazide diuretics. 

Although erectile dysfunction is sometimes assumed to be a symptom of the aging process in men, it is unclear if the incidence is directly related to increasing patient age. Erectile dysfunction more likely results from concurrent medical conditions of the patient (e.g., hypertension, arteriosclerosis, hyperlipidemia, diabetes melli-tus, or psychiatric disorders) or from medications that patients may be taking for these diseases. " For example, up to 50% of patients with diabetes mellitus develop erectile dysfunction, and medications such as /3-blockers are associated with a high incidence of erectile dysfunction. 

Diseases that compromise vascular flow to the corpora caver-nosum (e.g., peripheral vascular disease, arteriosclerosis, and essential hypertension) are associated with an increased incidence of erectile dysfunction. Diseases that impair nerve conduction to the brain (e.g., spinal cord injury or stroke) or conditions that impair peripheral nerve conduction to the penile vasculature (e.g., diabetes mellitus) can result in erectile dysfunction. 

The first step in clinical management of erectile dysfunction is to identify, and if possible to reverse, underlying causes. Risk factors for erectile dysfunction, including hypertension, diabetes mellitus, smoking, or chronic ethanol abuse, should be addressed and mini-... 

Boulton AJ, Selam JL, Sweeney M, Ziegler D. Sildenafil Citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus. Diabetologia 2001 44(10) 1296-1301. 

Vascular pathology may involve lesions of the inflow or outflow mechanisms of penile erection. Erectile dysfunction may be a manifestation of generalized atherosclerosis and may even be its initial presentation. Common risk factors associated with generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation (Rosen et al. 1991). Less commonly, local stenosis of the conunon penile artery may occur in men who have sustained blunt pelvic or perineal trauma (Levine et al. 1990). 

Chronic renal failure is also frequently associated with diminished erectile function, impaired libido, and infertility. The mechanism is probably multifactorial low serum testosterone concentrations, diabetes mellitus, vascular insufficiency, multiple medications, autonomic and somatic neuropathy, and psychological stress. Men with angina, myocardial infarction, or heart failure may have erectile dysfunction from anxiety, depression, or concomitant penile arterial insufficiency. 

Erectile dysfunction may be the first manifestation of many diseases including diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, spinal-cord compression, pituitary tumors, and pelvic malignancies. For example, a recent prevalence study found that men with erectile dysfunction were twice as likely to have DM and concluded that erectile dysfunction may be used as an early marker for DM. This relationship was particularly strong in the younger age groups, in vdiich the odds ratio of having DM was 3 (Sun et al. 2006). Two earlier studies found that 11% (Maatman et al. 1987) and 12% (Deutsch and Sherman 1980) of impotent men were found to have previously undiagnosed DM. 

A 54-year-old hypertensive and diabetic man presented witii intractable neuropathic pain despite intrathecal morphine injection. His medical history included hypertension and diabetes mellitus which he has had for 30 years with complications including pol5meuropathy with bladder dysfunction and erectile dysfunction. Good erectile function had been achieved in the past 5 years on testosterone treatment. He has had intrathecal administration of morphine for 9 years. Despite dose escalation, considerable pain relief had not been achieved. A trial of Ziconotide was stopped because it did not provide any pain relief but ratiier caused severe side effects. A combination of morphine and clonidine was delivered by a programmable pump. Considerable pain relief was achieved in 2 weeks at a clonidine dose of 0.04 mg per day. However, he developed erectile dysfunction and relative hypotension immediately he commenced clonidine because of which he opted to stop clonidine and revert back to morphine monotherapy. Thereafter, erectile dysfunction disappeared and BP reverted back to habitual high levels... 

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