Treating Erectile Dysfunction
Erectile dysfunction is a common incident in men with diabetes. The incidence of impotence increases progressively with age, from 5% in men age 20 to 75% in men over age 65. The reason for impotence in men with diabetes is typically associated with a decline in the blood supply to the penis along with to injury to the nerves that are responsible for the erection mechanism. A decrease in testosterone production has likewise been identified as the cause in some men with diabetes.
Since 1998, when sildenafil (brand name Viagra) first began the marketplace, oral therapy has been successfully used to treat impotence in lots of men with diabetes. (Sildenafil was followed in 2003 by the drugs tadalafil [Cialis] and vardenafil [Levitra], both of which operate in similar method.) Some 50% of men with Type 1 diabetes who try the drugs report enhanced erections, and some 60% men with Type 2 diabetes do, too. However, that leaves a big portion of men with diabetes and impotence who do not react to therapy with one of these tablets. This article takes a look at what can be done to treat those men who do not respond to oral therapy.
Why therapy stops working
There are a number of factors a man may not accomplish the preferred result from an oral erectile dysfunction drug. Sometimes, a man might experience drug side effects severe enough to outweigh any potential benefit of taking the drug. Possible side effects of these drugs include headache, facial flushing, nasal blockage, and short-term irregular vision. (In October 2007, the FDA added a warning about sudden hearing loss to the package labels of oral erectile dysfunction drugs. While it’s not definitely clear that the drugs can cause sudden hearing loss, a number of cases have actually been reported in men within hours or days of taking among the drugs.)
Another common factor for failures of oral therapy is the lack of sexual or genital stimulation prior to trying sexual relations. These medications facilitate an erection by increasing blood circulation to the penis, but they do not function as an aphrodisiac or as an initiator of the erection. A man who is not “in the mood” or does not have appropriate physical stimulation will not respond with an erection.
Yet another reason for the drugs not to work as intended is the usage of a high-fat meal before or along with taking the drug. The fat in such a meal can decrease absorption of the medication from the intestinal tract.
It’s likewise possible for anxiety about intercourse after a prolonged period of abstaining, fear of side effects, or unaddressed mental issues such as guilt or spiritual concerns about taking part in sexual intimacy to interfere with the capability to obtain and maintain an erection.
In a number of these cases, a discussion in between the doctor, the man with erectile dysfunction, and possibly his partner can help to deal with the problems resulting in treatment failure. For men who experience severe side effects, can’t take the drugs for other reasons (such as taking medications such as nitroglycerin), or don’t react in spite of additional education on the appropriate use of the drugs, there are other treatment alternatives that can help most men remain sexually active.
See also: Type 1 Diabetes Life Expectancy
Using oral drugs appropriately
For oral impotence medications to work as desired, they should be used appropriately in the first place. This implies taking the medication 30 — 45 minutes prior to taking part in sexual intimacy; taking the drug on an empty stomach or a minimum of preventing a heavy or high-fat meal prior to taking the drug (this is especially important when using sildenafil); and participating in appropriate genital stimulation prior to trying sexual intercourse. Drinking small amounts of alcohol (one to two drinks) need to not jeopardize the effectiveness of impotence medications, however larger amounts of alcohol can decrease a man’s capability to have an erection.
A man needs to try the medicine at least 4 times prior to he concludes that it doesn’t work for him. It is not likely that a man with diabetes who has other medical issues such as high blood pressure, is taking numerous medications, and has not had sexual intercourse for several years will be able to have an erection appropriate for intercourse the first time he takes a pill. A lot of men have to attempt the medicine numerous times prior to they have the wanted results.
Some physicians prefer to begin a man on the most affordable dose of an oral medicine and increase the dosage till a reliable one is found. Others prefer to begin with the greatest dose and go to a lower dose just if a man experiences side effects. In either case, it’s crucial for a man to interact with his doctor to let him understand how the dosage he’s utilizing is working.
For some men, daily administration of a low dose of among the oral medicines may result in enhanced blood supply to the penis, resulting in better erections.
Switching from one of the oral medicines to another might be attempted before continuing to a more invasive or more expensive treatment. However, there are few studies that reveal any among the drugs being significantly more effective than another.
Prior to a man concludes that oral drugs do not work for him, he should have his testosterone levels checked to eliminate hormonal agent deficiency as the reason for (or as a contributor to) his sexual dysfunction. Other symptoms of low testosterone consist of a low sex drive and infertility. Inspecting testosterone levels requires a blood test. If a man’s levels of testosterone are reduced or at the lower end of normal, his doctor might prescribe extra testosterone therapy, either as testosterone injections or testosterone gel, which is applied daily to the skin. Sometimes, testosterone therapy alone can fix sexual dysfunction, or it can be integrated with making use of oral erectile dysfunction drugs.
Mix therapy has shown reliable for some men who don’t react adequately to oral medications. The concept is to use two drugs with different systems of action for better outcomes. Commonly, sildenafil is used in mix with pellets of alprostadil (synthetic prostaglandin E1) that are placed into the urethra (the tube in the penis that brings urine from the bladder to the outside of the body). Alprostadil likewise increases the blood supply to the penis, but by different ways.
Alprostadil can likewise be injected directly into the penis. A very little needle about the size of those used to inject insulin is used for this function, so any pain or pain should be very little. Penile injections can be used alone or in mix with an oral drug.
Yet another typical impotence treatment that can be used in combination with oral drugs is a vacuum pump. This device includes a plastic cylinder, a pump, a set of tightness bands, and a water-soluble lubricant. The lube is used to the base of the penis to help form an airtight seal. The cylinder is positioned over the drooping penis and held tight against the pelvis. The pump is used to create a vacuum within the cylinder, drawing blood into the penis. When the penis is engorged with blood, a tightness band is rolled off the cylinder to near the base of the penis. The constraint band is practical for men with venous leakage, in which blood flows out of the penis as quick as it streams in. However, it should be left on for no more than 30 minutes at a time.
Surgery for erectile dysfunction is normally considered just after all other choices have actually failed. The two surgical choices include the insertion of a semi-rigid rod or the implantation of a three-piece inflatable prosthesis. Penile prosthesis implantation has low infection, complication, and malfunction rates. Nevertheless, given that positioning of an implant needs irreversible injury to the erectile tissue of the penis, implant treatment is thought about irreversible.
The emotional side
No matter what the cause of impotence, it is likely to cause sensations of stress and other psychological responses. It’s also not unusual for erection issues to cause tension in a relationship, especially if one or both partners withdraws mentally and the problem is not talked about. And it’s possible for a man’s renewed ability to make love after a period of no sexual activity to stir up relationship problems.
Seeing a psychologist or sex therapist, for that reason, can be valuable for many men or couples, even if the origins of sexual dysfunction are physical. A therapist can help a private or couple to communicate more easily, feel less distressed, and develop practical expectations for sex.
The bottom line is that nearly all men with diabetes who wish to have an erection adequate for sexual intercourse can do so with the treatments presently available. And with commitment and communication, the experience of erectile dysfunction can be altered from a potential individual tragedy to an opportunity for higher psychological intimacy in a couple.