Main Article Content
The first part of the review article highlights modern views on the prevalence, etiology and features of the pathogenesis of erectile dysfunction (ED) in men with diabetes mellitus. Google Scholar and PubMed databases were used to search for literature sources. The role of comorbid diseases in the development of ED in men with diabetes mellitus has been shown. The generalized data on the main clinical manifestations of erectile dysfunction, methods of its diagnosis and treatment are given. A number of epidemiological studies over the past 20 years have found that erectile dysfunction in men with diabetes may be an early marker of cardiovascular complications. Thus, in the algorithm for ED diagnosis in patients with diabetes it is necessary to conduct a thorough examination of the cardiovascular system. Numerous literature sources indicate an important role in the correction of androgen deficiency in men with type 2 diabetes, in order to enhance the effectiveness of phosphodiesterase type 5 inhibitors. Erectile dysfunction involves a change in any of the components of an erectile response. ED can negatively affect a man’s quality of life because most patients experience symptoms of depression and anxiety related to their sexual capabilities. These symptoms also affect a partner’s sexual experience and the couple’s quality of life. Clinical features of ED have many key features in the anamnesis, including some physical signs during examination depending on a type of diabetes. With age, comorbid conditions play an increasing role in the development of ED. Diabetes mellitus, cardiovascular diseases, obesity can lead to the development of ED before accelerated deterioration of erectile function and disorders at the molecular level of the mechanisms underlying erection. Patients with diabetes and ED have higher scores on the depression rating scale, and poorer overall health and quality of life. Early detection of ED in individuals with diabetes can improve the overall health and quality of life of patients. Patients with diabetes with poor glycemic control and older age are more likely to develop severe ED, which further exacerbates an already compromised health and quality of life. According to the National Health and Nutrition Examination Survey (2001–2002), diabetes mellitus is a modified risk factor independently associated with the development of ED (odds ratio (OR) 2.69), obesity (OR 1.60), smoking (OR 1.74) and hypertension (OR 1.56). Erectile dysfunction is a common complication of diabetes, and diabetes is a risk factor for ED; men with diabetes are three times more likely to have ED.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Li HJ, Bai WJ, Dai YT, Xu WP, Wang CN, Li HZ. An analysis of treatment preferences and sexual quality of life outcomes in female partners of Chinese men with erectile dysfunction. Asian J Androl. 2016 Sep-Oct;18(5):773-9. doi: 10.4103/1008-682X.159719.
Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007 Aug 23;357(8):762-74. doi: 10.1056/NEJMoa067423.
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. 1994 Jan;151(1):54-61. doi: 10.1016/s0022-5347(17)34871-1.
Corona G, Lee DM, Forti G, O'Connor DB, Maggi M, O'Neill TW, et al. Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J Sex Med. 2010 Apr;7(4 Pt 1):1362-80. doi: 10.1111/j.1743-6109.2009.01601.x.
Luchytskyy V, Tronko M, Luchytskyy E. Aspects of Testosterone Replacement Therapy in Men With Type 2 Diabetes Mellitus and Testosterone Deficiency. Mìžnarodnij endokrinologìčnij žurnal. 2019;15(2):99-105, doi:10.22141/2224-07220.127.116.119.166099.
Nelson CJ, Mulhall JP, Roth AJ. The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. J Sex Med. 2011 Feb;8(2):560-6. doi: 10.1111/j.1743-6109.2010.02127.x.
Jannini EA, Sternbach N, Limoncin E, et al. Health-related characteristics and unmet needs of men with erectile dysfunction: a survey in five European countries. J Sex Med. 2014 Jan;11(1):40-50. doi: 10.1111/jsm.12344.
Kouidrat Y, Pizzol D, Cosco T, et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017 Sep;34(9):1185-92. doi: 10.1111/dme.13403.
Anwar Z, Sinha V, Mitra S, et al. Erectile dysfunction: an underestimated presentation in patients with diabetes mellitus. Indian J Psychol Med. 2017 Sep-Oct;39(5):600-4. doi: 10.4103/0253-7176.217015.
Giugliano F, Maiorino M, Bellastella G, Gicchino M, Giugliano D, Esposito K. Determinants of erectile dysfunction in type 2 diabetes. Int J Impot Res. 2010 May-Jun;22(3):204-9. doi: 10.1038/ijir.2010.1.
Lindau ST, Tang H, Gomero A, et al. Sexuality among middle-aged and older adults with diagnosed and undiagnosed diabetes: a national, population-based study. Diabetes Care. 2010 Oct;33(10):2202-10. doi: 10.2337/dc10-0524.
Nikolaidou B, Nouris C, Lazaridis A, Sampanis C, Doumas M. Diabetes mellitus and erectile dysfunction. In: Viigimaa M, Vlachopoulos C, Doumas M, editors. Erectile dysfunction in hypertension and cardiovascular disease. Cham, Heidelberg, New York, Dordrecht, London: Springer International Publishing; 2015. pp. 119-128. doi: 10.1007/978-3-319-08272-1.
Walle B, Lebeta KR, Fita YD, Abdissa HG. Prevalence of erectile dysfunction and associated factors among diabetic men attending the diabetic clinic at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia, 2016. BMC Res Notes. 2018 Feb 15;11(1):130-5. doi: 10.1186/s13104-018-3211-2.
Rosen RC, Wing RR, Schneider S, et al. Erectile dysfunction in type 2 diabetic men: relationship to exercise fitness and cardiovascular risk factors in the Look AHEAD trial. J Sex Med. 2009 May;6(5):1414-22. doi: 10.1111/j.1743-6109.2008.01209.x.
Montorsi P, Ravagnani PM, Galli S, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005 Dec 26;96(12B):19M-23M. doi: 10.1016/j.amjcard.2005.07.006.
Yaman O, Akand M, Gursoy A, Erdogan MF, Anafarta K. The effect of diabetes mellitus treatment and good glycemic control on the erectile function in men with diabetes mellitus-induced erectile dysfunction: a pilot study. J Sex Med. 2006 Mar;3(2):344-8. doi: 10.1111/j.1743-6109.2006.00221.x.
Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, Muneer A. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men-2017. J Sex Med. 2018 Apr;15(4):430-457. doi: 10.1016/j.jsxm.2018.01.023.
Rubin RR, Ma Y, Marrero DG, et al. Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program. Diabetes Care. 2008 Mar;31(3):420-6. doi: 10.2337/dc07-1827.
Sáenz de Tejada I, Angulo J, Cellek S, González-Cadavid N, Heaton J, Pickard R, Simonsen U. Pathophysiology of erectile dysfunction. J Sex Med. 2005 Jan;2(1):26-39. doi: 10.1111/j.1743-6109.2005.20103.x.
Fonseca V, Jawa A. Endothelial and erectile dysfunction, diabetes mellitus, and the metabolic syndrome: common pathways and treatments? Am J Cardiol. 2005 Dec 26;96(12B):13M-8M. doi: 10.1016/ j.amjcard.2005.07.005.
Usta MF, Kendirci M, Gur S, et al. The breakdown of preformed advanced glycation end products reverses erectile dysfunction in streptozotocin-induced diabetic rats: preventive versus curative treatment. J Sex Med. 2006 Mar;3(2):242-50; discussion 250-2. doi: 10.1111/j.1743-6109.2006. 00217.x.
Bertolotto M, Neumaier CE, Martinoli C, Quaia E, Savoca G. Color Doppler appearance of penile cavernosal-spongiosal communications in patients with normal and impaired erection. Eur Radiol. 2002 Sep;12(9):2287-93. doi: 10.1007/s00330-002-1347-9.
Corona G, Rastrelli G, Isidori AM, et al. Erectile dysfunction and cardiovascular risk: a review of current findings. Expert Rev Cardiovasc Ther. 2020 Mar;18(3):155-64. doi: 10.1080/14779072. 2020.1745632.
Banks E, Joshy G, Abhayaratna WP, et al. Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med. 2013;10(1):e1001372. doi: 10.1371/journal.pmed.1001372.
Derosa G, Romano D, Tinelli C, D'Angelo A, Maffioli P. Prevalence and associations of erectile dysfunction in a sample of Italian males with type 2 diabetes. Diabetes Res Clin Pract. 2015 May;108(2):329-35. doi: 10.1016/j.diabres.2015.01.037.
Shiferaw WS, Akalu TY, Aynalem YA. Prevalence of erectile dysfunction in patients with diabetes mellitus and its association with body mass index and glycated hemoglobin in Africa: a systematic review and meta-analysis. Int J Endocrinol. 2020 Jan 18;2020:5148370. doi: 10.1155/2020/5148370.
Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002 Aug;25(8): 1458-63. doi: 10.2337/diacare.25.8.1458.
Inman BA, Sauver JL, Jacobson DJ, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009 Feb;84(2): 108-13. doi: 10.4065/84.2.108.
Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013 Jan 1; 6(1):99-109. doi: 10.1161/CIRCOUTCOMES.112.966903.
Jackson G, Boon N, Eardley I, et al. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010 Jun;64(7):848-57. doi: 10.1111/j.1742-1241.2010.02410.x.
Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile dysfunction as a cardiovascular risk factor: time to step up? Curr Vasc Pharmacol. 2021;19(3):301-12. doi: 10.2174/ 1570161118666200414102556.
Eaton CB, Liu YL, Mittleman MA, Miner M, Glasser DB, Rimm EB. A retrospective study of the relationship between biomarkers of atherosclerosis and erectile dysfunction in 988 men. Int J Impot Res. 2007 Mar-Apr;19(2):218-25. doi: 10.1038/sj.ijir.3901519.
Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab. 2004 Nov;89(11):5462-8. doi: 10.1210/jc. 2004-0804.
Kupelian V, Araujo AB, Chiu GR, Rosen RC, McKinlay JB. Relative contributions of modifiable risk factors to erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Prev Med. 2010 Jan-Feb;50(1-2):19-25. doi: 10.1016/j. ypmed. 2009.11.006.
Guo W, Liao C, Zou Y, et al. Erectile dysfunction and risk of clinical cardiovascular events: a meta-analysis of seven cohort studies. J Sex Med. 2010 Aug;7(8):2805-16. doi: 10.1111/j.1743-6109.2010.01792.x.
Polonsky TS, Taillon LA, Sheth H, Min JK, Archer SL, Ward RP. The association between erectile dysfunction and peripheral arterial disease as determined by screening ankle-brachial index testing. Atherosclerosis. 2009 Dec;207(2):440-4. doi: 10.1016/j. atherosclerosis.2009.05.005.
Prezioso D, Iacono F, Russo U, et al. Evaluation of penile cavernosal artery intima-media thickness in patients with erectile dysfunction. A new parameter in the diagnosis of vascular erectile dysfunction. Our experience on 59 cases. Arch Ital Urol Androl. 2014 Mar 28;86(1):9-14. doi: 10.4081/aiua.2014.1.9.
Yamada T, Hara K, Umematsu H, Suzuki R, Kadowaki T. Erectile dysfunction and cardiovascular events in diabetic men: a meta-analysis of observational studies. PLoS One. 2012;7(9):e43673. doi: 10.1371/journal. pone.0043673.
Gray PB, Singh AB, Woodhouse LJ, et al. Dose-dependent effects of testosterone on sexual function, mood, and visuospatial cognition in older men. J Clin Endocrinol Metab. 2005 Jul;90(7):3838-46. doi: 10.1210/jc.2005-0247.
Corona G, Rastrelli G, Filippi S, Vignozzi L, Mannucci E, Maggi M. Erectile dysfunction and central obesity: an Italian perspective. Asian J Androl. 2014 Jul-Aug;16(4):581-91. doi: 10.4103/1008-682X.126386.
Corona G, Giorda CB, Cucinotta D, Guida P, Nada E; Gruppo di studio SUBITO-DE. Sexual dysfunction at the onset of type 2 diabetes: the interplay of depression, hormonal and cardiovascular factors. J Sex Med. 2014 Aug;11(8):2065-73. doi: 10.1111/jsm.12601.