Sexual dysfunction among diabetics, remedies for each situation (II) Systematic screening
Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. The main factors associated with erectile dysfunction in populations of men with diabetes are older age, smoking, long-term evolution of the disease. Other important factors are poor glycemic control, hypertension or smoking related, or even the existence a diuretic or blocker.
All men with diabetes and should periodically be screened individually for erectile dysfunction by means of a questionnaire on sexual function. Screening for erectile dysfunction should be done from the moment you make a diagnosis of type 2 diabetes.
More and more doctors are also considering erectile dysfunction as a sentinel symptom of cardiovascular disease. The risk of myocardial infarction is four times higher when erectile 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 (arteries of the heart). Erectile dysfunction in men with diabetes is sometimes an early indicator of the occurrence of complications, which reinforces the interest of its screening.
Erectile dysfunction, when it is neglected by the physician, can also be a factor for depression, cause significant discomfort and frequent rejection of the diabetic disease. Patients consider the even third among the most worrying complications of their disease.
The importance of consultation screening
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 look for other sexual dysfunction (desire, ejaculation, reports).
must also specify the permanent or situational (eg according to the partner), the possible persistence of nocturnal erections and / or spontaneous morning which evokes primarily a psychological origin.
The severity of erectile dysfunction should be estimated. It is desirable to question the patient about her sexual past. The evaluation of the impact is an important factor, and the reasons for the consultation. Must specify the current context of sexual and emotional patient and his couple, and find a possible family or professional repercussions.
The doctor will also collect information on the partner, on his attitude and sexual motivation, the existence of sexual problems with her (decreased desire, anorgasmia), its moral and physical health in general and particularly on its potential gynecological problems, hormonal status (menopause) or method of contraception.
Beyond examining the patient, essential during the first visit of a diabetic with erectile dysfunction, an additional minimum balance is shown, particularly cardiovascular. The assessment of risk factors is warranted during follow-up of any diabetic, especially type 2.
However, the discovery of erectile dysfunction must make a special assessment of cardiovascular status (lipid, HbA1c, creatinine, proteinuria). The initial assessment may include a complementary mix of bioavailable testosterone, LH, prolactin levels and PSA (prostate), especially when the patient is over 50 years. Other specialized explorations may be prescribed by the specialist on a case by case basis.
