Endocrine Abstracts

Erectile failure is a common yet often neglected complication of diabetes that may have a significant negative effect on quality of life and diabetes self-care. I would initially try to ensure a good ascertainment rate of the problem in men attending the diabetes service. I would encourage, though usually fail to persuade men to attend with their partners. I would ascertain the exact nature of the problem, the likely cause, the importance of the problem to the man, the nature of the relationship and partner's attitude, and the desired action / treatment desired by the man. I would explain the choice of available treatments including PDE5 inhibitors (and other oral treatments), intracavernosal alprostadil self-injection (Caverject dual chamber), Vacuum Devices and possible combination treatments. The possibility of surgical intervention to implant penile prostheses would be discussed because a significant number of men with diabetes have end-stage corpora cavernosal muscle disease and do not respond to other treatments. The strong association between erectile failure and cardiovascular disease will need to be considered and, if necessary, adequately investigated and treated, occasionally prior to the resumption of sexual activity and treatment of the impotence. Discontinuation of nitrates should be considered in men desiring to try PDE5 Inhibitors. Oral PDE5 inhibitor treatment is currently the usual first choice and an adequate trial is important before abandoning it as ineffective. Vacuum devices are now available on NHS prescription. Men embarking on self-injection treatment require instruction on technique and a safe incremental home dosing programme. Most men suffering with this important problem can now be successfully treated and treatments should now largely be the province of the diabetes care team.