Changes in male sexual function

Abstract

Sexual dysfunction is a frequent complication in men with type 2 diabetes. The prevalence of sexual dysfunction in this population is high, with an estimated 35% to 75% of men experiencing some degree of sexual dysfunction.

In men, erectile dysfunction (ED) is the most common manifestation. Up to one third of men have ED at the time of diagnosis of type 2 diabetes. This population may also have other alterations in sexual function such as decreased sexual desire, premature ejaculation or retrograde ejaculation.

The etiological mechanisms of sexual dysfunction in patients with type 2 diabetes are multifactorial and complex. One of the main factors is vascular dysfunction. Chronic hyperglycemia damages the vascular endothelium, affecting the release of nitric oxide, resulting in decreased vasodilation necessary for erection. This is aggravated by insulin resistance, since insulin normally acts by stimulating the production of nitric oxide in the endothelium of the corpora cavernosa. Metabolic syndrome is significantly more prevalent in patients with ED.

Neurological damage, or diabetic neuropathy, also plays a key role. Autonomic neuropathy can affect the nerves involved in sexual response, including those that control erection and ejaculation.

Type 2 diabetes can also alter the gonadal axis, contributing to sexual dysfunction. This is mainly due to an alteration in the hypothalamic activity of the gonadotropin-releasing factor. This determines a high prevalence of hypogonadism in men with type 2 diabetes, which generates a decrease in sexual desire and worsens erectile dysfunction.

Given the high frequency of this complication and the importance of sexual function in the quality of life of patients, we emphasize the need to investigate this problem in all men with Type 2 Diabetes.

In summary, sexual dysfunction in patients with Type 2 Diabetes is a frequent complication that results from a combination of vascular, neurological and endocrine disorders, underscoring the need for a comprehensive approach in the management of these patients.

Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study.