ERECTILE DYSFUNCTION

2003 Clinical Practice Guidelinesfor the Prevention and Management

of Diabetes in Canada

ERECTILE DYSFUNCTION

Erectile dysfunction (ED) affects approximately 34 to

45% of men with diabetes.

Risk factors include increasing age, increasing duration

of diabetes, poor glycemic control, smoking,

hypertension, dyslipidemia and cardiovascular disease.

Psychological and situational factors may also cause or

contribute to erectile dysfunction.

SCREENING

Screening for ED with a sexual function history should

be performed on all adult men with diabetes at

diagnosis and periodically thereafter.

TREATMENT

While no randomized trial has demonstrated that interventions that

improve glycemic control also reduce the incidence or progression of

ED, both the DCCT and UKPDS showed that intensive glycemic

control was effective for the primary prevention of and secondary

intervention for neuropathy.

Type 5 phosphodiesterase (PDE5) inhibitors can be used to treat ED

and should be offered as first-line therapy to men with diabetes

wishing treatment. PDE5 inhibitors are contraindicated if the man

has unstable angina, poor exercise tolerance or uses any form of

nitrate medication.

ERECTILE DYSFUNCTION- RECOMMENDATIONS

All adult men with diabetes should be periodically screened

for ED with a sexual function history. Screening for ED in

men with type 2 diabetes should begin at diagnosis of

diabetes [Grade D, Consensus].

A PDE5 inhibitor should be offered as first-line therapy to

men with diabetes with ED wishing treatment if there are

no contraindications to its use [Grade A, Level 1A].

Referral to a specialist in ED should be considered for men

who do not respond to PDE5 inhibitors of for whom the use

of PDE5 inhibitors is contraindicated [Grade D, Consensus].