Dr. Shalabh Samdarshi

Type 2 diabetes is reaching pandemic levels and young-onset type 2 diabetes is becoming increasingly common. Erectile dysfunction (ED) is a common and distressing complication of diabetes. The pathophysiology and management of diabetic ED is significantly different to nondiabetic ED.

Aim
To provide an update on the epidemiology, risk factors, pathophysiology, and management of diabetic ED.
Method
Literature for this review was obtained from Medline and Embase searches and from relevant text books.
Main Outcome Measures
A comprehensive review on epidemiology, risk factors, pathophysiolgy, and management of diabetic Erectile Dysfunction.

Results
Large differences in the reported prevalence of ED from 35% to 90% among diabetic men could be due to differences in methodology and population characteristics. Advancing age, duration of diabetes, poor glycaemic control, hypertension, hyperlipidemia, sedentary lifestyle, smoking, and presence of other diabetic complications have been shown to be associated with diabetic ED in cross-sectional studies. Diabetic ED is multifactorial in aetiology and is more severe and more resistant to treatment compared with nondiabetic ED. Optimized glycaemic control, management of associated comorbidities and lifestyle modifications are essential in all patients. Psychosexual and relationship counseling would be beneficial for men with such coexisting problems. Hypogonadism, commonly found in diabetes, may need identification and treatment. Maximal doses of phosphodiesterase type 5 (PDE5) inhibitors are often needed. Transurethral prostaglandins, intracavenorsal injections, vacuum devices, and penile implants are the available therapeutic options for nonresponders to PDE5 inhibitors and for whom PDE5 inhibitors are contraindicated. Premature ejaculation and reduced libido are conditions commonly associated with diabetic ED and should be identified and treated.

Conclusions
Aetiology of diabetic ED is multifactorial although the relative significance of these factors are not clear. A holistic approach is needed in the management of diabetic ED.

Psychosexual counseling in diabetic patient 
In order to avoid the problems inherent in the assessment of any organic component of impotence, a consecutive series of 20 diabetics were treated with psychotherapy after a detailed assessment of the psychological components of their disability, 13 patients improved in the long term and responders could not be identified from pretreatment characteristics. However, most of the patients had been impotent for several years and their successful adaptation may have limited the success of psychotherapy. There is a need to identify the impotent patient at an early stage in order to offer more effective treatment. This might also avoid the problems of adaptation and the need for detailed investigations of pelvic nervous and vascular function. The management of ED in the diabetic patient may often involve a multidisciplinary approach where psychosexual counselling and specialist Sexologist advice is required in addition to the skills of the diabetologist. Finally, the introduction of the new oral agents have completely revolutionised the management of ED and allowed more individuals to come forward for treatment.

Infertility is a condition, which is characterized by the inability to have a baby for over a year in spite of having planned and unprotected sex. It is a pretty common phenomenon for both men and women. However, there are several treatments available for both the sexes to help them recover from this problem. Here are some of the most common treatments available for infertility:

For Men

1. Changing your lifestyle: Certain factors in your lifestyle, which may cause you to be infertile include the medications you take, lack of exercise or not having intercourse frequently enough or not at the right time. The solution for these problems is simply incorporating certain changes in your daily life, such as exercising more, sticking to a healthy diet or having intercourse more often at the right time.

2. Sperm retrieval: Sperm retrieval is the technique used when you cannot ejaculate or when there is hardly any sperm present in your semen. It is also used in case of a low sperm count.

For Women

1. Intrauterine insemination: Intrauterine insemination is a process in which healthy sperm cells are put into the uterus so that the egg gets fertilized when it is released. The sperm cells have to be inserted at the time when your ovaries release eggs; therefore it is crucial to know your menstrual cycle as well as how fertility drugs are affecting it.

2. Fertility drugs: Fertility drugs are used to stimulate ovulation. This is done by administering medications which either regulate or cause ovulation to occur. There are several types of fertility drugs, so you should talk to your doctor about which should be the best for you.

3. Hysteroscopic surgery: This is a last resort, which is taken only when there are significant problems such as intrauterine scar tissue, uterine septum or endometrial polyps.

4. IVF: IVF is an assisted reproductive technology. During IVF, the sperm is first retrieved, after which fertility medications are given to the woman so that the egg can be retrieved. Finally, the egg is fertilized on a laboratory dish and injected back into the mother or a surrogate mother.