Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions

Sexual health questionnaires identifying erectile dysfunction can be used as a tool for the early detection of cardiovascular disease, coronary heart disease, stroke, and T2DM in men.

Discussions about sexual health are essential, given that around 12-30% of men reported erectile dysfunction (ED) as their first symptom of T2DM. Men with T2DM can develop erectile dysfunction due to microvascular changes associated with diabetes, neuropathy, and endothelial dysfunction. Research suggests that erectile dysfunction is linked to conditions such as hypertension, obesity, and heart disease. It can dramatically increase the risk of CVD, coronary heart disease, stroke, and all-cause mortality. Therefore, the researchers of this study wanted to determine the prevalence of erectile dysfunction in men with T2DM.

This cross-sectional study from Nepal analyzed 160 male patients with T2DM who attended an outpatient diabetes center from January 2019 to December 2019. Inclusion criteria included men with T2DM who were in a stable relationship and had history of hypertension. Additionally, the study excluded participants with a history of psychiatric disorders, cardiovascular disease, kidney disease, endocrine disease, neurological disorders, and surgery. Patients with medications or chronic conditions that impair erectile function were also excluded. ED was assessed using an abbreviated version of the International Index of Erectile Function (IIEF-5) questionnaire. Individuals with an IIEF5 score

The mean age was 45 years and the mean IIEF5 score was 17.5. Most of the men in the study were non-smokers (n = 143) and did not consume any form of alcohol (n = 134). The prevalence of erectile dysfunction in men with T2DM was 77%, with widely varying severity: normal (n = 37), mild (n = 61), mild to moderate (n = 44), moderate (n = 11), severe (n = 7). There was a significantly higher presence of ED in individuals with a higher A1C (8.64% vs. 6.8%) and a longer duration of T2DM (4.9 years vs. 2.3 years) (p

The severity of erectile dysfunction was significantly associated with a prolonged history of T2DM [<5 years (18.91± 4.05), 6-10 years (15.19 ± 4.29), >10 years (13.78 ± 5.26), (p<0.05). Patients with T2D and hypertension had a significant rise in severity of ED compared to individuals with T2D alone [T2DM (IIEF 18.23 ± 4.32), T2DM with hypertension (IIEF 15.36 ± 5.07), p <0.05]. IIEF5 scores were slightly higher in active smokers compared to non-smokers. There was no significant association between erectile function and alcohol consumption (p-value 0.58).

Previous studies found that up to 90% of diabetic patients suffered from erectile dysfunction, with figures varying by location: Ireland (59%), Pakistan (62.5%), Japan (64.6%), Republic Slovak (75%), China (59%), Japan (43%), Italy (19%). The prevalence of ED in Nepalese patients with T2DM was 76.87%. Researchers believe that cultural differences as well as the patient / doctor relationship could play a role in this disparity. The provision of questionnaires to patients increased the number of reported cases of erectile dysfunction in this population. However, patients were unwilling to present their symptoms before receiving the survey. This study highlighted the importance of a comprehensive sexual health history and physical exam for every man. This vital screening tool can be a quick and easy way for physicians to screen for cardiovascular health.

Practice the beads:

  • The prevalence of erectile dysfunction in 160 men with T2DM was 77%, with widely varying severity: normal (n = 37), mild (n = 61), mild to moderate (n = 44), moderate (n = 11), severe (n = 7).
  • There was a significantly higher presence of erectile dysfunction in individuals with a higher A1C (8.64% vs. 6.8%) and a longer duration of T2DM (4.9 years vs. 2.3 years). Conversely, there was no significant difference in erectile dysfunction in people with a higher BMI or a higher waist circumference.
  • An increased severity of erectile dysfunction was significantly associated with a prolonged history of T2DM. Additionally, patients with T2DM and hypertension also saw a significant increase in the severity of erectile dysfunction compared to people with T2D alone.

Salonia A, Castagna G, Sacca A, Ferrari M, Capitanio U, Castiglione F, et al. Is erectile dysfunction a reliable indicator of men’s general health? The case of the international index of erectile function-domain of erectile function. The Journal of Sexual Medicine. 2012; 9 (10): 2708-15.

Tamrakar D, Bhatt DS, Sharma VK, Poudyal AK, Yadav BK. Association between erectile dysfunction and type 2 diabetes mellitus. J Nepal Health Res Council Sep 6, 2021; 19 (2): 378-383. doi: 10.33314 / jnhrc.v19i2.3394. PMID: 34601534.

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions


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