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Diabetes mellitus
Management of erectile dysfunction in diabetic patients
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Background Services Available
- Preliminary assessment of the diabetic patient with Erectile Dysfunction
is outlined below:
- Management options are described and several are suitable for initiation /
trial in primary care.
- More complex issues requiring specialist advice can be referred to DRC, Sr
Mary Oswald / Mr Thomas at Wansbeck Hospital; Mr Powell at Freeman Hospital;
Paul Holt (Diabetes Consultant Hexham General.
This is a big problem affecting 50% of diabetic men with duration of DM 5-10
years. Often not discussed and a source of considerable psychological distress
leading to depression and break-up of relationships.
Main Causes of Erectile Dysfunction in Diabetic Patients
- Hyperglycaemia
- Drugs Neuropathy
- Psychological
- Vascular
History in patient with ED
Nature of problem
- Mode of onset
- Degree of disability
- Precipitating factors
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General
- Medical Hx
- Psychiatric Hx
- Surgery
- Drugs
- Alcohol / Smoking
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Lab investigations
- General
- Endo:
- Testosterone / sex hormone binding globulin
- Prolactin
- TFT
- HbAlc
Routine clinical investigations for ED and other diseases associated with
erectile dysfunction
Clinical Examination
The routine clinical examination for Frectile Dysfbnction should include the
following:
- Physical examination of the penis and testes
- BP
- Urinalysis or a random blood sugar to identify diabetes.
For patients with loss of libido (sexual drive), consider:
- Random testosterone level - to screen for hypogonadism.
If testosterone levels are low, measurement of SHBG, FSH/LH and/or prolactin
levels will help to identify the most likely cause. Further investigations
should be considered based upon findings from the patients history and
examination.
Other Diseases associated with Erectile Dysfunction
- CVS
- Neuro
- CVA
- Epilepsy
- Spinal injury
- Dementias
- Endo
- Hyperprolactinaemia
- Thyroid
- Hypogonadism
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- Systemic
- Renal Failure
- Haemachromatosis
- Cirrhosis
- Arthritis
- Malignancy
- Other
- Smoking
- ETOH
- Surgery
- Drugs
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Physical examination
- General
- Body Habitus
- Hair distribution
- Muscle mass
- Fat distribution
- CVS
- BP
- Peripheral pulses inc. Abdo Aorta
- Neuro
- Lower limb sensation
- Anal tone and sensation
- Abdo
- Hepatomegaly
- Splenomegaly
- Genitalia
- Size and shape of Penis
- Abnormalities of prepuce
- Testicular size
- Prostate size
Drugs linked to erectile dysfunction
- Cardiovascular Drugs
- Thiazide diuretics
- Calcium antagonists
- Beta Blockers
- Centrally acting agents
- Methyldopa
- Clonidine, reserpine
- Ganglion blockers
- Digoxin
- Lipid lowering agents
- ACE inhibitors
- Psychotropic Drugs
- Major tranquilisers
- Anxiolytics & hypnotics
- Tricyclic antidepressants
- Selective serotonin re-uptake inhibitors
- Endocrine Drugs
- Antiandrogens
- Oestrogens
- LHRH analogues
- Testosterone
- Recreational drugs
- Alcohol
- Marijuana
- Amphetamines
- Cocaine
- Heroin
- Others
- Cimetedine & Ranitidine
- Metoclopramide
- Carbimazepine
- Anabolic steroids
Source: Northumbria NHS Health Care Trust diabetes protocol