At any time, up to half of men with diabetes may be experiencing erectile dysfunction (ED), according to Aruna V. Sarma, PhD, MHA.

“Not only are we seeing significantly more ED, we’re actually seeing ED occur at younger ages than what you see in the general population,” said Dr. Sarma, Chief and Professor, Dow Division of Health Services Research in the Department of Urology, and Professor in the Department of Epidemiology at the University of Michigan.

Dr. Sarma and Deepak K. Jumani, MBBS, FCGP, discussed Male Sexual Dysfunction in Diabetes on Friday, June 12, during this year’s Scientific Sessions. The presentation can be viewed by registered meeting attendees at ADA2020.org through September 10, 2020. If you haven’t registered for the Virtual 80th Scientific Sessions, register today to access all of the valuable meeting content.

Dr. Sarma reviewed data from the UroEDIC study, an ancillary study of urological and sexual complications in type 1 diabetes patients from the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study of the Diabetes Control and Complications Trial. UroEDIC began in 2003.

Dr. Sarma said that during the second arm of UroEDIC, which began in 2010, participants were starting to report more symptoms of bladder dysfunction and ED. But some participants were demonstrating remission and having intermittent ED instead of persistent ED, she said.

Patients with persistent ED were more likely to be associated with autonomic neuropathy than other common type 1 diabetes risk factors. In patients with intermittent ED, the associated risk factors tended to be related to body size, behavior characteristics, and insulin control.

Dr. Sarma also reported that men not taking antihypertensive medication with increased blood pressure had a 20% increased risk of ED with every unit increase of systolic blood pressure. This demonstrates that there are specific characteristics and actions men with diabetes can take, she said.

Sexual health matters to many diabetes patients, Dr. Sarma noted, so this data could help motivate some men to better control their diabetes.

“It’s much more likely that you’ll get a 20-year-old with type 1 diabetes to control their insulin levels if you tell them there’s a potential for erectile dysfunction, rather than trying to describe what’s, for them, a very abstract notion of potential amputation perhaps 50 years later,” she said.

Dr. Jumani, Senior Sexual Health Physician and Counselor at the Sir JJ Group of Hospitals & Grand Government Medical College in Mumbia, India, discussed the medical management of ED. He emphasized the need to ask every male diabetes patient about ED symptoms, adding that about 70% of men with ED have comorbid cardiovascular disease.

Management begins with one simple question to rule out psychogenic problems: Does the patient get morning erections?

First-line ED treatment includes an oral medication, preferably a phosphodiesterase 5 (PDE5) inhibitor, with chronic therapy of 5 mg or 10 mg optimal for diabetes patients. Additional treatment options include penile injection, vacuum pumps, and intraurethral agents. Surgery is the final treatment option.

Dr. Jumani, who called diabetes “the sexual health tsunami of our century,” said the most important treatment is counseling and lifestyle improvements, such as improved diet and better nutrition.

“Erectile dysfunction, friends, is ‘correctile’ dysfunction,” he said. “Don’t let your patients with diabetes die in bits. If you (use these interventions), sex has no expiry date.”