Male Sexual Dysfunction in Diabetes Mellitus

  • Albert C. Leung
  • Arnold Melman

Abstract

Male sexual dysfunction can be classified in the following categories: erectile dysfunction (ED); orgasmic and ejaculatory dysfunction; priapism; and decreased libido. Of these various dysfunctions, more patients with ED are likely to seek medical attention. ED, or impotence, is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual function1. In recent years, there has been an escalated awareness of ED, partly attributed to the advent of ViagraTM and its associated promotion. The impact of ED can be appreciated by the estimation that its prevalence in men 40 to 70 years old is 52%, based on the Massachusetts Male Aging Study.2 Based on these data and United States population projections for the year 2005 of more than 50 million men 40 to 70 years old, ED will affect more than 25 million men, and millions more over the age of 70. The projected worldwide prevalence of ED for year 2025 will be staggering at 322 million men. Certain patients are found to have a significantly higher prevalence of ED; for example, diabetic men command a more than threefold increase in risk of ED than their nondiabetic counterparts. Indeed, diabetes mellitus is the single most common cause of ED.2 More than 50% of diabetic patients are afflicted with some degree of ED, and approximately 50% of the patients evaluated at our Center for Male Sexual Dysfunction are diabetic.

Keywords

Erectile Dysfunction Vasoactive Intestinal Polypeptide Autonomic Neuropathy Penile Erection Penile Prosthesis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    NIH Consensus Development Panel on Impotence. NIH Consensus Conference. JAMA 270: 83, 1993.CrossRefGoogle Scholar
  2. 2.
    Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151: 54–61, 1994.PubMedGoogle Scholar
  3. 3.
    Zonszein J. Diagnosis and management of endocrine disorders of erectile dysfunction. Urol Clin N Am 22: 789–802, 1995.Google Scholar
  4. 4.
    Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin N Am 22: 699–709, 1995.Google Scholar
  5. 5.
    Ellenberg M Impotence in diabetes: the neurologic factor. Ann Intern Med 75: 213–219, 1971.Google Scholar
  6. 6.
    Ellenberg M. Sexual function in diabetic patients. Ann Intern Med 92: 331–333, 1980.PubMedCrossRefGoogle Scholar
  7. 7.
    Ryder RE, Close CF, Moriarty KT, Moore KT, Hardisty CA. Impotence in diabetes: aetiology, implications for treatment and preferred vacuum device. Diabetes Med 9: 893–898, 1992.CrossRefGoogle Scholar
  8. 8.
    Melman A, Gingell JC. The epidemiology and pathophysiology of erectile dysfunction. Urol 161: 5–11, 1999.CrossRefGoogle Scholar
  9. 9.
    Buvat J, Lemaire A, Buvat-Herbaut M, et al. Comparative investigations in 26 impotent and 26 nonimpotent diabetic patients. J Urol 133: 34–38, 1985.PubMedGoogle Scholar
  10. 10.
    Cummings MH, Alexander WD. Erectile dysfunction in patients with diabetes. Hosp Med 60: 638–644, 1999.PubMedGoogle Scholar
  11. 11.
    Lehman TP, Jacobs JA. Etiology of diabetic impotence. J Urol 129: 291–294, 1983.PubMedGoogle Scholar
  12. 12.
    Christ GJ, Brink PR, Melman A, Spray DC. The role of gap junctions and ion channels in the modulation of electrical and chemical signals in human corpus cavernosum smooth muscle. Int J of Impotence Res 5: 77, 1993.Google Scholar
  13. 13.
    Goldstein I. Impotence (editorial). J Urol 51: 1533, 1994.Google Scholar
  14. 14.
    Lue TF. Erectile dysfunction associated with cavernous and neurological model (editorial). Am J Physiol 260: H1590, 1991.Google Scholar
  15. 15.
    Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev 75: 191, 1995.PubMedGoogle Scholar
  16. 16.
    Lerner SE, Melman A, Christ GJ. A review of erectile dysfunction: new insights and more questions. J Urol 149: 1246–1255, 1993.PubMedGoogle Scholar
  17. 17.
    McCulloch DK, Campbell IW, Wu FC, Prescott RJ, Clarke BF. The prevalence of diabetic impotence. Diabetologia 18: 279–283, 1980.PubMedCrossRefGoogle Scholar
  18. 18.
    Blanco R, Saenz de Tejada I, Goldstein I, Krane RJ, Wotiz HH, Cohen RA. Dysfunctional penile cholinergic nerves in diabetic impotent men. J Urol 144: 278–280, 1990.PubMedGoogle Scholar
  19. 19.
    Wagner G, Brindley GS. The effect of atropine, alpha and beta blockers on human penile erection: a controlled pilot study. In: Zorgniotti AW, Rossi G, eds. Vasculogenic Impotence. Proceedings of the First International Conference on Corpus Cavernosum Revascularization. Springfield, Illinois: Charles C Thomas Publishers, pp. 77–81, 1980.Google Scholar
  20. 20.
    Saenz de Tejada I, Goldstein I. Diabetic penile neuropathy. Urol Clin N Am 15: 17–22, 1988.Google Scholar
  21. 21.
    Melman A, Henry DP. The possible role of the catecholamines of the corpora in penile erection. Urol 121: 419–421, 1979.Google Scholar
  22. 22.
    Felten DL, Felten SY, Melman A. Noradrenergic innervation of the penis in control and streptozotocin-diabetic rats: evidence of autonomic neuropathy. Anat Rec 206: 49–59, 1983.PubMedCrossRefGoogle Scholar
  23. 23.
    Melman A, Henry DP, Felten DL. Catecholamine content of the penile corpora in patients with diabetes associated impotence. Surg Forum 29: 634–636, 1978.PubMedGoogle Scholar
  24. 24.
    Melman A, Henry DP, Felten DL, O’Connor BL. The effect of diabetes mellitus upon the sympathetic nerves of the penile corpora in patients with erectile impotence. South Med J 73: 307–309, 1980a.PubMedCrossRefGoogle Scholar
  25. 25.
    Melman A, Henry DP, Felten DL, O’Connor BL. Alteration of the nerves of the penile corpora in patients with erectile impotence. Invest Urol 17: 474–477, 1980.PubMedGoogle Scholar
  26. 26.
    Christ GJ, Maayani S, Valcic M, Melman A. Pharmacological studies of human erectile tissue: characteristics of spontaneous contractions and alterations in alpha-adrenoceptor responsiveness with age and disease in isolated tissues. Br J Pharmacol 101: 375–381, 1990.PubMedCrossRefGoogle Scholar
  27. 27.
    Gu J, Polak JM, Probert L, Islam KN, et al. Peptidergic innervation of the human male genital tract. J Urol 130: 386–391, 1983.PubMedGoogle Scholar
  28. 28.
    Adaiken PG, Kottegoda SR, Ratnam SS. Is vasoactive intestinal peptide the principal transmitter involved in human penile erection? J Urol 135: 638–640, 1986.Google Scholar
  29. 29.
    Gu J, Polak J, Lazarides M, Morgan RJ, et al. Decrease of vasoactive intestinal polypeptide (VIP) in the penises from impotent men. Lancet 2: 315–318, 1984.PubMedCrossRefGoogle Scholar
  30. 30.
    Crowe R, Lincoln J, Blacklay PF, Pryor JP, Lumley JS, Burnstock G. Vasoactive intestinal polypeptide-like immunoreactive nerves in diabetic penis. A comparison between streptozocin-treated rats and man. Diabetes 32: 1075–1077, 1983.PubMedCrossRefGoogle Scholar
  31. 31.
    Lincoln J, Crowe R, Blacklay PF, Pryor JP, Lumley JS, Burnstock G. Changes in the VIPergic, cholinergic and adrenergic innervation of human penile tissue in daibetic and non-diabetic impotent males. J Urol 137: 1053–1059, 1987.PubMedGoogle Scholar
  32. 32.
    Azadzoi K, Kim N, Brown ML, Goldstein I, Cohen RA, Saenz de Tejada I. Endothelium-derived nitric oxide and cyclooxygenase products modulate corpus cavernosum smooth muscle tone. Urol 147: 220–225, 1992.Google Scholar
  33. 33.
    Saenz de Tejada I, Carson MP, de las Morenas A, Goldstein I, Triash AM. Endothelin: localization, synthesis, activity, and receptor types in human penile corpus cavernosum. Am J Physiol 26: H1078–1085, 1991.Google Scholar
  34. 34.
    Christ GJ, Lerner EE, Kim DC, Melman A. Endothelin-1 as a putative modulator of erectile dysfunction: Characteristics of contraction of isolated corporal tissue strips. J Urol 153: 1998–2003, 1995.PubMedCrossRefGoogle Scholar
  35. 35.
    Francavilla S, Properzi G, Bellini C, Marino G, Ferri C, Santucci A. Endothelin-1 in diabetic and nondiabetic men with erectile dysfunction. J Urol 158: 1770–1774, 1997.PubMedCrossRefGoogle Scholar
  36. 36.
    Sullivan ME, Dashwood MR, Thompson CS, Muddle JR, Mikhailidis DP, Morgan RJ. Alterations in endothelin B receptor sites in cavernosal tissue of daibetic rabbits: potential relevance to the pathogenesis of erectile dysfunction. J Urol 158: 1966–1972, 1997.PubMedCrossRefGoogle Scholar
  37. 37.
    Bell CRW, Sullivan M, Dashwood MR, Muddle JR, Morgan RJ. The density and distribution of endothelin-1 and endothelin receptor subtypes in normal and diabetic rat corpus cavernosum. Br J Urol 76: 203–207, 1995.PubMedCrossRefGoogle Scholar
  38. 38.
    Kim N, Azadzoi K, Goldstein I, Saenz de Tejada I. A nitric oxide- like factor mediates nonadrenergic-noncholinergic neurogenic relaxation of penile corpus cavernosum smooth muscle. J Clin Invest 88: 112–118, 1991.PubMedCrossRefGoogle Scholar
  39. 39.
    Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med 326: 90–94, 1992.PubMedCrossRefGoogle Scholar
  40. 40.
    Seftel AD, Vaziri ND, Ni Z, Razmjouei K, Fogarty J, Hampel N, Polak J, Wang RZ, Ferguson K, Block C, Haas C. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology 50: 1016–1026, 1997.PubMedCrossRefGoogle Scholar
  41. 41.
    Makita Z, Vlassara H, Cercimi, Bucola R. Immunochemical detection of advanced glycosylation products in vivo. J Biol Chem 267: 5133–5138, 1992.PubMedGoogle Scholar
  42. 42.
    Maher E, Bachoo M, Elabbady AA, Polosa C, Begin LR, Collier B, Elhilali MM, Hassouna MM. Vasoactive intestinal peptide and impotence in experimental diabetes mellitus. Br JUrol 77: 271–278, 1996.CrossRefGoogle Scholar
  43. 43.
    Cellek S, Rodrigo J, Lobos E, Fernandez P, Serrano J, Moncada S. Selective nitrergic neurodegeneration in diabetes mellitus–a nitric oxide-dependent phenomenon. Br J Pharmacol 128: 1804–1812, 1999.PubMedCrossRefGoogle Scholar
  44. 44.
    el-Sakka AI, Lin CS, Chui RM, Dahiya R, Lue TF. Effects of diabetes on nitric oxide synthase and growth factors genes and protein expression in an animal model. Int J Impotence Res 11: 123–132, 1999.CrossRefGoogle Scholar
  45. 45.
    Sullivan M, Thompson CS, Mikhailidis DP, Morgan RJ, Angelini GD, Jeremy JY. Differential alterations of prostacyclin, cyclic AMP and cyclic GMP formation in the corpus cavernosum of the diabetic rabbit. Br J Urol 82: 578–584, 1998.PubMedCrossRefGoogle Scholar
  46. 46.
    Elabbady AA, Gagnon C, Hassouna MM, Begin LR, Elhilali MM. Diabetes mellitus increases nitric oxide synthase in penises but not in major pelvic ganglia of rats. Bri J Urol 76: 196–202, 1995.CrossRefGoogle Scholar
  47. 47.
    Basar MM, Yildiz M, Soylemezoglu F, et al. Histopathological changes and nitric oxide synthase activity in corpus cavernosum from rats with neurogenic erectile dysfunction. Br J Urol Int 83: 101–107, 1999.CrossRefGoogle Scholar
  48. 48.
    Miller MA, Morgan RJ, Thompson CS, Mikhailidis DP, Jeremy JY. Hydrolysis of cyclic guanosine monophosphate and cyclic adenosine monophosphate by the penis and aorta of the diabetic rat. Br J Urol 78: 252–256, 1996.PubMedCrossRefGoogle Scholar
  49. 49.
    Kolodny RC, Kahn CB, Goldstein HH, Barnett DM. Sexual dysfunction in diabetic men. Diabetes 23: 306–309, 1974.PubMedGoogle Scholar
  50. 50.
    Jensen SB. Sexual dysfunction in insulin-treated diabetes: a six year follow-up study of 101 patients. Arch Sex Behav 15: 271, 1986.PubMedCrossRefGoogle Scholar
  51. 51.
    Deutsch S, Sherman L. Previously unrecognized diabetes mellitus in sexually impotent men. JAMA 244: 2430–2432, 1980.PubMedCrossRefGoogle Scholar
  52. 52.
    Faerman I, Glocer L, Fox D, Jadzinsky MN, Rapaport M. Impotence and diabetes. Histological studies of the autonomic nervous fibers of the corpora cavernosa in impotent diabetic males. Diabetes 23: 971–976, 1974.PubMedGoogle Scholar
  53. 53.
    Bemelmans BL, Meuleman EJ, Doesburg WH, Notermans SL, Debruyne FM. Erectile dysfunction in diabetic men: the neurological factor revisited. J Urol 151: 884–889, 1994.PubMedGoogle Scholar
  54. 54.
    Melman A, Henry DP, Felten DL, O’Connor BL. Effect of diabetes upon penile sympathetic nerves in impotent patients. South Med J 73: 307–309, 317, 1980.Google Scholar
  55. 55.
    Christ GJ. The penis as a vascular organ. The importance of corporal smooth muscle tone in the control of erection. Urol Clin N Arne 22: 727–745, 1995.Google Scholar
  56. 56.
    Lee SW, Wang HZ, Christ GJ. Characterization of ATP-sensitive potassium channels in human corporal smooth muscle cells. Int J Impot Res 11: 189–199, 1999.PubMedCrossRefGoogle Scholar
  57. 57.
    Lee SW, Wang HZ, Zhao W, Ney P, Brink PR, Christ GJ. Prostaglandin El activates the large conductance KCa channel in human corporal smooth muscle. Int J Impotence Res 11: 179–188, 1999.CrossRefGoogle Scholar
  58. 58.
    Christ GJ, Moreno AP, Melman A, Spray DC. Gap junction-mediated intercellular diffusion of Ca in cultured human corporeal smooth muscle cells. Am J Physiol 263: C373, 1992.PubMedGoogle Scholar
  59. 59.
    Campos de Carvalho AC, Roy C, Moreno AP, Melman A, Hertzberg EL, Christ GJ, Spray DC. Gap junctions formed of connexin43 are found between smooth muscle cells of human corpus cavernosum. J Urol 149: 1568–1575, 1993.PubMedGoogle Scholar
  60. 60.
    Christ GJ, Moreno AP, Parker ME, Gondre CM, Valcic M, Melman A, Spray DC. Intercellular communication through gap junctions: potential role in pharmacomechanical coupling and syncytial tissue contraction in vascular smooth muscle isolated from the human corpus cavernosum. Life Sci 49:PL195, 1991.Google Scholar
  61. 61.
    Rehman J, Chenven E, Brink PR, Grine B, Walcott B, Melman A, Christ GJ. Diminished neurogenic-, but not pharmacologic-induced intracavernous pressure responses in the 3 month Streptozotocin (STZ)-diabetic rat. Am J Physiol 272: H1960 - H1971, 1997.PubMedGoogle Scholar
  62. 62.
    Giraldi A, Wen Y, Geliebter J, Christ GJ. Differential gap junction mRNA expression in human corpus cavernosum: a significant regulatory event in cell-to-cell communication? Urol 153: 508A, 1995.Google Scholar
  63. 63.
    Andersen J, Grine E, Eng CL, et al. Expression of connexin-43 in human myometrium and leiomyoma. Amer J Obst Gyn 169: 1266–1277, 1993.CrossRefGoogle Scholar
  64. 64.
    Risek B, Guthrie S, Kumar N, Gilula NB. Modulation of gap junction transcript and protein expression during pregnancy in the rat. J Cell Biol 110: 269–282, 1990.PubMedCrossRefGoogle Scholar
  65. 65.
    Persson C, Diederichs W, Lue TF, et al. Correlation of altered penile ultrastructure with clinical arterial evaluation. JUrol 142: 1462–1468, 1989.Google Scholar
  66. 66.
    Vernet D, Cai L, Garban H, et al. Reduction of penile nitric oxide synthase in diabetic BB/WORdp (type I) and BBZ/WORdp (type II) rats with erectile dysfunction. Endocrinol 136: 5709–5717, 1995.CrossRefGoogle Scholar
  67. 67.
    Kaiser FE, Udhoji V, Viosca SP, et al. Cardiovascular stress tests in patients with vascular impotence. Clin Res 37: 89A, 1989.Google Scholar
  68. 68.
    Virag R, Bouilly P, Frydman. Is impotence an arterial disorder? Lancet 1: 181–184, 1984.Google Scholar
  69. 69.
    Jevtich MJ, Edson M, Jarman WD, Herrera HH. Vascular factor in erectile failure among diabetics. Urol 19: 163–168, 1982.PubMedCrossRefGoogle Scholar
  70. 70.
    Heiman A, Adar R, Rubinstein Z. Vascular lesions associated with impotence in diabetic and nondiabetic arterial occlusive disease. Diabetes 27: 975–981, 1978.CrossRefGoogle Scholar
  71. 71.
    Akoi I, Shimoyama K, Aoki N, et al. Platelet dependent thrombin generation in patients with diabetes mellitus: effects of glycemic control on coagulopathy in diabetes. J Am Coll Cardiol 27: 560–566, 1996.CrossRefGoogle Scholar
  72. 72.
    Jensen T, Bjerre-Knudsen J, Feldt-Rasmussen B, Deckert T. Features of endothelial dysfunction in early diabetic nephropathy. Lancet 1: 461–463, 1989.PubMedCrossRefGoogle Scholar
  73. 73.
    Carrier S, Brock G, Kour NW, T.F. L. Pathophysiology of erectile dysfunction. Urology 42: 468–481, 1993.PubMedCrossRefGoogle Scholar
  74. 74.
    Rosen MP, Greenfield AJ, Walker TG, et al. Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastriccavernous arterial bed of men with arteriogenic impotence. J Urol 145: 759–63, 1991.PubMedGoogle Scholar
  75. 75.
    Krane RJ, Goldstein I, Saenz de Tejada I. Medical progress: impotence. N Engl J Med 321: 1648, 1989.PubMedCrossRefGoogle Scholar
  76. 76.
    Hakim LS, Goldstein I. Diabetic sexual dysfunction. Endocrinol Metab Clin North America 25: 379–400, 1996.CrossRefGoogle Scholar
  77. 77.
    Mottonen M, Nieminen K. Relation of atherosclerotic obstruction of the arterial supply of corpus cavernosum to erectile dysfunction. Proceedings of the Sixth Biennial International Symposium on Corpus Cavernosum Revascularization and Third Biennial World Meeting on Impotence. Boston: 12, 1988.Google Scholar
  78. 78.
    Davis-Joseph B, Tiefer L, Melman A. Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction. Urology 45: 498–502, 1995.PubMedCrossRefGoogle Scholar
  79. 79.
    Merckx LA, DeBruyne RMG, Goes E, Derde MP, Keuppens F. The value of dynamic color duplex scanning in the diagnosis of venogenic impotence. J Urol 148: 318–320, 1992.PubMedGoogle Scholar
  80. 80.
    Kropman RF, Schipper J, Oostayen JA, Nijeholt ABL, Meinhardt W. The value of increased end diastolic velocity during penile duplex sonography in relation to pathological venous leakage in erectile dysfunction. J Urol 148: 314–317, 1992.PubMedGoogle Scholar
  81. 81.
    Melman A, Tiefer L, Pedersen R. Evaluation of first 406 patients in urology department based Cneter for Male Sexual Dysfunction. Urology 32: 6–10, 1988.PubMedCrossRefGoogle Scholar
  82. 82.
    Haberman S, Bradley WE, Bhatia NN, Johnson BK. Pudendal evoked responses. Arch Neurol 39: 280, 1982.CrossRefGoogle Scholar
  83. 83.
    Nisen HO, Larsen A, Lindstrom BL, Ruutu ML, Virtanen JM, Alfthan OS. Cardiovascular reflexes in the neurological evaluation of impotence. Br J Urol 71: 199–203, 1993.PubMedCrossRefGoogle Scholar
  84. 84.
    Sharlip ID. Evaluation and nonsurgical management of erectile dysfunction. Urol Clin N Am 25: 647–659, 1998.CrossRefGoogle Scholar
  85. 85.
    Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA 281: 421–426, 1999.PubMedCrossRefGoogle Scholar
  86. 86.
    Price DE, Gingell JC, Gepi-Attee S, Wareham K, Yates P, Boolell M. Sildenafil: study of a novel oral treatment for erectile dysfunction in diabetic men. Diabetes Med 15: 821–825, 1998.CrossRefGoogle Scholar
  87. 87.
    Melman A. Neural and vascular control of erection. In: Rosen RC, Leiblum SR, eds. Erectile Disorder: Assessment and Treatment. New York: The Guilford Press, pp. 55–71, 1992.Google Scholar
  88. 88.
    Kim ED, McVary KT. Topical prostaglandin E-1 for the treatment of erectile dysfunction. Urol 153: 1828–1830, 1995.CrossRefGoogle Scholar
  89. 89.
    Beaser RS, Van der Hoek C, Jacobson AM, Flood TM, Desautels RE. Experience with penile prosthesis in the treatment of impotence in diabetic men. JAMA 248: 943–948, 1982.PubMedCrossRefGoogle Scholar
  90. 90.
    Scott FB, Fishman IJ, Light JK. An inflatable penile prosthesis for treatment of diabetic impotence. Ann Intern Med 92: 340–342, 1980.PubMedCrossRefGoogle Scholar
  91. 91.
    McCulloch DK, Young RJ, Prescott RJ, Campbell IW, Clarke BF. The natural history of impotence in diabetic men. Diabetologia 26: 437–440, 1984.PubMedCrossRefGoogle Scholar
  92. 92.
    Klein R, Klein BE, Lee KE, Moss SE, Cruickshanks KJ. Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 19: 135–141, 1996.PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  • Albert C. Leung
  • Arnold Melman

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