Health Centre - Dr Felix

What is sexual dysfunction?

Sexual dysfunction can be described as a situation where you have a problem that means you either do not want or do not enjoy sexual activity. Men and women can experience this at any age although the risks increase as a person gets older.

Sexual dysfunction can actually occur during any phase of the sexual response cycle and it prevents the person from experiencing sexual satisfaction; the phases of the response cycle are arousal, plateau, orgasm and resolution.

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There are a number of conditions that are related to sexual dysfunction and the main physical contributors include:

Heart disease
Vascular disease
Diabetes
Neurological disease
Some medication
Reduced hormone levels

There are also some psychological and related causes including:

Stress Anxiety
Sexual trauma
Drug abuse
Alcohol abuse

In this article, we are looking to explore the relationship between erectile dysfunction and underlying disease, in particular cardiovascular disease, neurological disease and diabetes.

The three main physical conditions that can cause sexual dysfunction are heart disease, vascular disease and diabetes. When we look a little closer at what causes what, we can see that whilst there are other factors that can cause heart disease, neurological disease and vascular disease, the common factor is diabetes.

Diabetes

The ‘bad boy’ in this story is diabetes, the long-term effects of which can create a situation that causes cardiovascular disease which is a disease in the heart and circulatory systems as well as neurological damage. In order to understand the relationship between these conditions and diabetes, we need to understand how diabetes can be a contributor factor in their development.

When we first consider diabetes, most people will think of high blood sugar. Many people do not understand just how important stable blood sugar levels are to our overall health. Unstable sugar levels, especially if they are present for a long period of time, can result in a person developing diabetes.

Diabetes is a serious condition when the glucose level in your blood is too high. This is a result of your body not producing enough insulin or any insulin at all.

Insulin is needed to help the body keep blood sugar levels stable. For example, when you eat food it turns into sugars which are released into the bloodstream. At this point in a healthy person, the body will release insulin from the pancreas and this will facilitate the uptake of excess sugar from the bloodstream and deposit the sugars into the tissues of the body. Here, the sugars are used for energy and any excess sugars are converted to glycogen and stored in the liver. When blood sugar levels drop, glycogen can be released from the liver in the form of glucose to raise sugar levels back up.

Effects of diabetes on systems of the body

When a person has diabetes, blood sugar levels can become very unstable with very high blood sugar which poses risks for many systems of the body.

Circulatory system

If unstable and high blood sugar levels are present in a diabetic person for long periods of time, the blood vessels can become damaged and this can result in ‘plaque’ deposits forming. This in turn leads to atherosclerosis which is a hardening of the arteries. The hardening of the arteries causes narrowing of the vessels which in turn causes a reduced ‘volume’ in the circulation. In turn, the pressure of the blood flow will increase and this is increased blood pressure.

The increased blood pressure puts a greater strain on the heart as it pumps harder to force the blood around the system. The incidence of heart disease and associated issues such as heart attack and stroke is around 50% greater in people who have diabetes.

Central nervous system

Diabetes can cause a condition known as diabetic neuropathy which is damage to the nerves; the damage can take the form of sensory neuropathy, motor neuropathy and autonomic neuropathy. The nervous system is responsible for all chemical messages sent to and from the brain and neuropathy may be present in as many as 50% of diabetes sufferers.

Although diabetes affects many parts of the body it is these two systems that are relevant to the relationship between cardiovascular disease and sexual dysfunction.

How is an erection achieved?

An erection is a response to a combination of factors involving the nervous system, the circulatory system and the endocrine system. When sexually aroused, a message from the brain sends chemical messages to the nerve endings in the penis. This causes the blood vessels to expand and so allowing increased blood flow into the penis. Muscles in the penis will then contract to prevent blood from flowing out of the penis.

How diabetes affects erectile function?

Causes of erectile dysfunction are extremely complex and are focused on changes that occur in the body over time; the changes are likely to affect nerve, muscle and blood vessel function. In order to achieve an erection, men need healthy blood vessels, healthy nerves, male hormones and to be sexually aroused.

As we know from earlier in the article, diabetes can result in constricted blood flow in damaged blood vessels along with nerve damage. With damage to both these functions, achieving an erection is likely to be a problem.

Heart disease and erectile dysfunction?

It is well understood that heart disease is a major contributory factor in erectile dysfunction, as is diabetes. However, the damage caused to the circulatory system by diabetes, also contributes to heart damage, so the diseases are very much entwined. I think that we have to ask the question, is heart disease a cause of erectile dysfunction or is erectile dysfunction an early warning system or developing heart disease?

Erectile dysfunction treatment

There are many treatments now available for erectile dysfunction but the best option will be down to what is causing the problem.

We have been discussing physical causes of erectile dysfunction, that caused by vascular damage and that caused by nerve damage.

Phosphodiesterase 5 inhibitors (PDE 5 inhibitors)

These oral medications are indicated in the treatment of erectile dysfunction. This form of medication is usually a ‘first stop’ when treating most types of erectile infections. They are the group of drugs to which Sildenafil (Viagra) Tadalafil, Vardenafil and Avanafil belong.

Alprostadil

Another medication treatment is Alprostadil which can be given as a self-administered injection, suppository placed in the end of the penis or via lotion or cream.

Mechanical devices

Other possible treatments include vacuum pump devices. These consist of a plastic tube in which your penis is placed. A pump is then used to extract air from the tube to create a vacuum. This, in turn, encourages blood flow from the body to the penis; a rubber ‘ring’ is placed around the base of the penis to prevent blood from flowing back out of the penis.

Surgery

The final option and a last resort for many men is surgery. This can be used for introducing various types of erectile implants or for performing vascular repair where this is appropriate.

The most suitable treatment for diabetes and ED will very much depend on the health of the patient and their own ability to tolerate treatment. Specialists, such as urologists can work with a person in order to help them make the best choice.

Conclusion

As we have discussed, diabetes is a major factor in looking at the relationship between erectile dysfunction, cardiovascular disease and diabetes itself. It is clear that diabetes can be responsible for causing conditions that are major contributory factors in heart disease, vascular disease and neurological disease, all of which are major contributors to sexual function.