More than half of people with diabetes, men and women encounter difficulties in their sexual lives. Their quality of life is profoundly disturbed. Do not hesitate to talk to your doctor, to adopt the most appropriate treatment.
Disorders of sexual function caused by diabetes have been described long ago. Avicenna’s writings already mentioned in the tenth century, referring to “the collapse of sexual function as a specific complication of the disease.” This topic is to share then taboo for many centuries, and it took until the 1950s to see the appearance of the medical literature on this subject. Sexual disorders are now considered an important aspect of diabetes complications, and have become a subject of forefront in research in all its aspects.
Half Of People With Diabetes Affected By Sexual Disorders
It is estimated that the prevalence of diabetes in France is around 4%, or about 2.5 million people, which must be added about 500,000 to 800,000 people who live in ignorance of their disease.
Among these patients, more than half of this sexual dysfunction potentially related to their illness. Sexuality becomes a prominent problem in the diabetic patient’s daily life, including his well-being.
According to the Association for the development of information and research on sexuality (ADIRS), two thirds of patients wish to help, through information, drugs or sex therapy. Diabetic patients also expect their doctor brings up the subject during consultations. Demand for care is increasing steadily.
In women, there is a sex dysfunction in 18-27% of cases of type 1 diabetes and in 42% of cases of type 2 diabetes. A diabetic woman has about twice the risk of sexual dysfunction than non-diabetics. The factors responsible for this lack of data is the lack of representativeness of questionnaires dealing with sexual dysfunction, the complexity of the assessment of female sexuality and finally changes depending on the hormonal status. Physicians who are interested are often marked in diabetic women, such as disorders of orgasm.
The specialist who deals with sexual dysfunction in men with diabetes is andrologist. The main clinical manifestations of sex in diabetic humans are primarily erectile dysfunction. Followed by ejaculation disorders.
Approximately 66% of diabetic patients suffer from sexual concrete: erectile dysfunction (60%), ejaculation disorder (24%) and disorders of desire or libido (24%). 70% of them, these disorders have degraded their quality of life and sometimes cause a rejection of treatment.
Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. The main factors associated with diabetic men populations are older age, smoking, long-term evolution of the disease. Other important factors are poor glycemic control, hypertension or smoking related, even the existence of a diuretic or blocker.
All men and diabetics should be periodically screened individually using a questionnaire on sexual function. Screening for it should be done from the moment you make a diagnosis of type 2 diabetes.
More doctors also consider it as a sentinel symptom of cardiovascular disease. The risk of myocardial infarction is four times higher when this dysfunction occurs between 40 to 50 years.
The value of this symptom is therefore essential to assess the cardiovascular risk of the patient, the arteries of the penis is slightly smaller than the coronary arteries (heart arteries). Erectile men dysfunction with diabetes is sometimes an early indicator of the onset of complications, which reinforces the interest of its screening.when neglected by the doctor, can also be a factor in depression, cause ill be important and frequent rejection of the diabetic disease. Patients even consider the third most worrying complication of their disease.
The importance of screening consultation
During the consultation, screening should be initiated by the andrologist with a simple question (lack of rigidity during intercourse) or by a questionnaire. The interview will then be conducted to search for other sexual disorders (desire, ejaculation, reports).
You must also specify the permanent or situational (eg according to the partner), the possible persistence of nocturnal erections and / or spontaneous morning evokes primarily a psychological origin.
The severity should be estimated. It is advisable to ask the patient about his sex life before. The impact assessment is an important factor, as well as the reasons for the consultation. It should be noted the current emotional and sexual patient and his partner, and seek potential impact family or professional.
The doctor will also collect information on the partner on his attitude and sexual motivation, the existence of sexual disorders at home (decreased desire, anorgasmia), on his mental and physical health in general and particularly on its any gynecological problems, hormonal status (menopause) or the method of contraception.
Beyond examining the patient, indispensable during the first consultation of a diabetic with erectile dysfunction, a complementary minimum balance is shown, particularly cardiovascular. The assessment of risk factors is warranted during follow any diabetic, particularly type 2.
However, the discovery of it must especially make an assessment of cardiovascular status (lipid profile, HbA1c, creatinine, proteinuria). The assessment may include a complementary initial dosage of bioavailable testosterone, LH, prolactin levels and PSA (prostate), especially when the patient has more than 50 years. Other specialized investigations may be prescribed by the specialist in each case.
A wide variety of treatments suitable for diabetics
The main treatments available are of different natures. Diabetes control is essential. It should encourage patients to be more balanced as possible. Specific treatments are mainly targeted drugs . Drug treatments available are the first PDE5 inhibitors, prostaglandins and intra-urethral and intracavernous injections.
Inhibitors of phosphodiesterase type 5 (PDE5 inhibitors) are usually offered first-line therapy in the treatment of dysfunction in diabetic patients. The three molecules are available sildenafil (Viagra ©), tadalafil (Cialis ©) and vardenafil (Levitra ©). The PDE5 inhibitors can thus improving the duration and quality of erections. These molecules have effect subject to the existence of a sexual stimulus. Their action is facilitator. Known side effects are facial flushing (hot flashes), headache and nasal congestion. Their frequency is less than 10%. The combination with nitrates is against absolute contraindications.
The sexual act is also a physical effort can be cons-indicated or not recommended in case of severe coronary artery disease. In diabetic patients, the efficacy of treatment with PDE5 inhibitors is approximately 50 to 60%. Please note, these drugs are expensive and are not covered by Social Security in diabetic patients.
Intracavernous injections (ICI) is a local treatment, inducing erection, which has a significant effectiveness in diabetic patients. Injections are currently available second-line. They are not cons-indicated in cases of effective anticoagulation or aspirin. Compared to PDE5 inhibitors, their effectiveness is better, since it is close to 90%.
A rigorous learning technique is required (role of a practitioner trained in andrology). This learning is facilitated in people with diabetes who inject insulin because they are already familiar with the technical handling of syringes and are not reluctant to proceed themselves to the injection.
The main side effects are pain, mainly at the beginning of treatment, a hematoma at the puncture without serious nature or pharmacologically prolonged erections. The refund is possible in diabetic patients.
Do not overlook the psychosomatic dimension
It is also possible to administer a gel into the urethra by a stick, but the use is not widespread. Vacuum pump or vacuum may be proposed in diabetics, but the acceptance of this technique in France remains low.
The surgical penile prostheses are an option in diabetics, although the risk of infection is slightly higher. These penile implants allow patients to regain erections when drugs no longer work. The patient should ask the surgeon about it to learn about the advantages and disadvantages of these prosthetic penis some of which are specially designed for diabetic patients.
Finally, it should not neglect the psychosomatic dimension at the expense of support with medication. Improve the intimacy of the couple, offer sex therapy behavioral relaxation about sexual …
Often andrologist working relationship with a psychotherapist. Psychotherapy is always beneficial for patients who need to take their sexuality, during a discussion that weaves décomplexante after several sessions.
In conclusion, sexual disorders are prominent in diabetic patients and should never be overlooked. They are dominated by dysfunction, sometimes associated with a high cardiovascular risk.
Diabetic men should not hesitate to consult an andrologist if these symptoms interfere with their daily lives. The comprehensive approach is often blurred, but a thorough consultation can detect the most obvious problems and propose a suitable medication.
Subjective sexual disorders, especially disorders of desire and sexual satisfaction are the responsibility of psychotherapy and sex therapy.