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Diabetes is a very common cause of erectile dysfunction (ED). Clinical
experience and numerous studies suggest that at least 50 percent of diabetic
patients will experience difficulties with erections. As patients age, this
problem increases significantly. Erectile dysfunction affects diabetic patients
who use oral medications for diabetic control as well as those patients who use
insulin. In some cases, ED can early symptom of diabetes.
Success rates of treatments
Oral drugs: The three oral medications available— brand names Viagra,
Cialis, and Levitra— have been used successfully to treat diabetic patients
with erectile dysfunction. In general, however, the success rate of these
medications is less than the reported success rates in the general population.
Diabetic men may have success rates of approximately 50 to 60 percent with these
medications. Success rates will vary depending on the severity of the problem
among the diabetic population being treated.
Injection treatment: When oral medications are ineffective, intracavernous
injection therapy (the injection of medication directly into the erection
chamber of the penis) may be helpful in facilitating intercourse. Among diabetic
men, the success rates with this method range from 60 to 80 percent. The
medications used include:
- alprostadil (brand names Caverject Impulse, Edex,
and Prostin VR),
- papaverine hydrochloride, and
- phentolamine mesylate.
In many cases, it may take a mixture of the three medications to produce an
adequate erectile response. Although injections may be reasonably effective in
diabetic patients, there is generally a long-term discontinuation rate of
approximately 50 percent after several years.
Vacuum Constriction Device (VCD): This device consists of an acrylic
cylinder that is placed over the penis. A lubricant is used to create a good
seal between the body and the cylinder. A pump mechanism is used to create a
vacuum inside the cylinder, allowing a patient to achieve an adequate
erection. If an adequate erection can be achieved, a band or ring is then
placed over the base of the penis (the part of the penis closest to the body)
and is used to help maintain the erection. These devices have been helpful in
facilitating intercourse among diabetic patients. While the early
effectiveness rate may be approximately 80 percent, longer-term studies
suggest less satisfaction with this device over time.
Intraurethral therapy: This treatment involves placing into the urethra
(canal in the penis that carries urine) a suppository or pellet that is
deposited by means of an applicator system. The applicator is placed into the
urethra. The insertion is usually not uncomfortable. The applicator length is
relatively small so that it is placed only into the tip of the penis. The
medication contained in the pellet is one of the medicines that is used for
injection therapy (alprostadil), but contains fifty to one hundred times more
medication. This is because the medication has to be absorbed by the urethra
and travel to the erection chamber.
Penile implants: Clinical studies have shown a high degree of patient
satisfaction with penile implants when other therapies have proven to be
ineffective. Patients need to be suitable surgical candidates and it is
preferable that patients have reasonably good diabetic control before surgery.
Problems with implants include a small incidence of infection, which would
the require removal of the implant and the placement of a new implant. Another
problem is device malfunction, which would make it necessary to remove the
device and consider inserting a new one.
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