Erectile Dysfunction in Diabetic Men - Literature review Example

Institution : xxxxxxxxxxx Title : Literature Review Tutor : xxxxxxxxxxx Course : xxxxxxxxxxx @2010 Literature Review on Erectile Dysfunction in Diabetic Men Introduction The main aim of the review is to provide information on the frequency of erectile dysfunction in a wide-ranging populations, allowing overview of the findings of a given population level. It complements the lately published systematic reviews which both showed the heterogeneity of the published evidence. In addition, the prevalence of Erectile Dysfunction in groups with major comorbidities and its impact on the health care system is discussed. According to Barclay (2009), Erectile Dysfunction refers to the lack of the ability to attain proper erection or the trend to maintain just to the point erections adequate enough for a satisfactory sexual action. These differences make defining Erectile Dysfunction, as well as approximating its occurrence, more complex. It is at times referred to as “impotence”, which also explains various problems that hampers sexual activities as well as reproduction. These include lack of sexual interest and difficulty with ejaculation or orgasm. The National Kidney and Urologic Diseases Information Clearinghouse, (2005) notes that employing the phrase Erectile Dysfunction puts it clear that the other problems are not implicated. . A survey carried out by the National Ambulatory Medical Care Survey in United States, found out that, in every 1000 men, approximately 7.7 physician visits were cases of Erectile Dysfunction in 1985. Come the year 1999, the number tripled to 22.3 with the rise occurring steadily, with treatments using vacuum devices as well as drug injections getting more extensively available and discussing the problem of Erectile Dysfunction becoming acknowledged (NKUDIC, 2005). NKU DIC (2005) points out that the most revealed progress was the introduction of the use of oral drug, Viagra (sildenafil citrate) in 1998. National Ambulatory Medical Care Survey data on the use of new drugs revealed that a projected 2.6 million mentions of Viagra at a physician’s in 1999, and one-third out of those mentions took place in visits for a diagnosis save for Erectile Dysfunction. The National Kidney and Urologic Diseases Information Clearinghouse, (2005) argues that among older men, Erectile Dysfunction more often than not comes with physical sources, for instance illness, injury, or side effects coming out of the usage of drugs. Culley (2004) adds that any disorder that leads to injury in the nerves or messes up blood flow at the penis has the prospective to cause Erectile Dysfunction. These incidences rise as an individual gets older: Approximately 5% of 40 year old men and those aged between 15-25 % of 65 year old men experience Erectile Dysfunction. However, this is not a usual part of the aging process. But it is not an inevitable part of aging (NKU DIC, 2005). Culley (2004) insists that Erectile Dysfunction is treatable at all ages, and its understanding has been rising. More men have been looking for assistance as well as recovering to usual sexual activity due to improved, thriving treatments for Erectile Dysfunction. Urologists specializing in problems related to urinary tract have customarily treated Erectile Dysfunction; however, they only make for 25 % of Viagra mentions in the year 1999 (The National Kidney and Urologic Diseases Information Clearinghouse,2005). Erectile Dysfunction Prevalence The lately epidemiological literature on erectile dysfunction (ED) by NKU DIC (2005) suggests that about 5-20% of men have moderate to severe ED.Various definitions, age variations as well as the associated medical conditions and methodological variances, may explain the differences in reported prevalence rates. According to Penson & Wessells (2004), a number of persistent disorders related levels of ED comprise of depression diabetes, cardiovascular as well as neurological ailments. However, a number of men go through extensive distress coming out of their condition, such that the ever-increasing understanding of ED as well as the availability of non-invasive treatments may lead to a greater proportion of patients looking for treatment, and eventually getting satisfaction throughout their sex life. Causes of Erectile Dysfunction Jonas et al (1991) argues that due to the fact that appropriate erection requires a steady sequence of events, ED takes place when any one of the events is hampered with. These include brain nerves, spinal column, and area surrounding the penis.Injuries to these areas mostly due to a disease, is the major cause of ED. Diseases such as diabetes, kidney problems, alcoholism among others make up for approximately account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED. Lifestyle choices that lead to heart problems as well as vascular cases also lead to the threat of erectile dysfunction. Smoking, overweight problems and lack of exercise are capable of erectile dysfunction. Smoking, for example has an effect on blood flow within the veins as arteries leading to various abnormalities such as lack of enough testosterone. Experts too have a belief those psychological reasons including stress, poor self-esteem, depression as well as the fear of sexual failures result to 10-20% of the erectile dysfunction problem (The National Kidney and Urologic Diseases Information Clearinghouse, 2005). Penson (2004) says that erectile dysfunction is more prominent with men who have diabetes. This comes out from problems related to poor as well as long term blood sugar control that destroys blood vessels as well as the nerves. It can also be associated with other conditions familiar with men with diabetes, such as high blood pressure. Penson (2004) adds that having erectile dysfunction has proved as a major challenge leaving many men and their partners feeling upset and discouraged. It has been predicted that approximately 35-75 per cent of diabetic men experience some level of erectile dysfunction within their lifetime (Penson et.al, 2004). According to Manzella (2008), men are also more liable to experiencing the erectile dysfunction at about 10 to 15 years earlier than men who have no diabetes. As diabetic men grow older, the problem tends to become more common. At the age of more than 50 years, the probability of experiencing difficulty with an erection happening in almost 50-60 per cent of diabetic men. At the age above 70, there is approximately 95 per cent probability of experiencing some problems with the erectile function (Manzella, 2008). Diagnosis of Erectile Dysfunction Culley (2004) supposes that Medical as well as the sexual histories are of great significance in describing the degree of ED. He says that it helps in revealing infections that result to ED cases, whereas a simple unfolding of the patients past sexual activities might help decide between the cases revolving around sexual interest, appropriate erection or orgasm. This is possible because certain prescription can propose a chemical cause, due to the fact that drug use, make up for about 25% of the ED problems. According to Morales et al (2009), a physical test can provide a hint to the continuing problems. For instance, in a situation where the penis is not responding to touch, it could be a problem with the nervous system as the cause. Through physical tests on the patient, the examiner is capable of coming out with several discoveries out of unusual signs on the penis suggesting the major causes of ED (Morales et al, 2009). Penson & Wessells (2004) confirm that a number of laboratory examinations can also help diagnose ED cases. Tests for continuing ailments include blood tests, urine analysis, lipid report as well as liver enzymes. Measurements of the level of testosterone found in the patients’ blood can provide information related to problems of the endocrine system and is often found especially in patients with decreased sexual interest. Penson & Wessells (2004) also note that examining erections happening while the patient is asleep can assist in ruling out various psychological ED related causes. Examinations on nocturnal erections are, however not totally reliable. This is because Scientists have no uniform examinations and have not found out when they can be practical for better results. A psychosocial examination, by means interviews as well as the use of questionnaires on patients, discloses psychological factors. A patient’s sexual partner can also be interviewed to decide the prospects as well as the perceptions during sexual activities (Giugliano et al. 2010). Effect of Erectile Dysfunction on Quality of Life in Men with Diabetes Manzella (2008) argues that although ED is a widespread problem of diabetes, its impacts on the quality of life of the patient is not yet well understood. Current work for the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) database show that in the total population of patients at their various urologists, ED pose negative impacts on both the general as well as health quality of life of the patient. Men with diabetes build up sexual problems as a result of injuries caused to the nerves as well as the blood vessels. Giugliano et al. (2010) note that nerve signals control various organs such as the heart and bladder therefore signaling the body to circulate blood without an individual having to think about it. The body’s reaction to every sexual stimulus is often involuntary, and controlled by autonomic nerve signals that enhance blood flow towards the genitals ensuring the smooth muscle tissues relax. Injury to these autonomic nerves hampers the usual function therefore leading to damage of the blood vessels. All these have a direct impact on the quality of life (Manzella, 2008). According to Penson & Wessells, (2004), Erectile Dysfunction is treatable at all ages, and its understanding has been rising. More and more men have been looking for assistance as well as recovering to usual sexual activity due to improved, thriving treatments for Erectile Dysfunction. Most physicians recommend that treatments progress starting from the least going on to the most complex. Medical as well as sexual history assessments are therefore always of great significance. Psychotherapy and patient’s behavior alterations in some patients are given considerations, followed by oral or drug injections, vacuum devices, as well as surgically implanted devices. In few cases, surgery relating to veins or arteries is considered (Jonas et al., 1991). In Psychotherapy, physicians always work on psychologically related ED using methods that reduce anxiety linked to the intercourse. Giugliano et al. (2010) argue that the patient's partner is able to assist with the methods, which incorporates steady development of intimacy as well as stimulation. These methods assist ease anxiety when ED coming out of physical causes is being worked on. Vacuum devices lead to erection through the creation of a fractional space that draws blood to the penis, expanding it. The vacuum device has three parts consisting of a plastic, where the penis is put; a pump, which removes air from the cylinder; as well as an elastic band put around the penis to sustain steady erection once the cylinder is removed, thereby stopping blood getting back to the body (Penson & Wessells, 2004). According to Culley (2004), drugs used for treating ED may be taken orally, injected or inserted into urethra through the penis’ tip. The Viagra pill, the first pill to be used for treating ED, was permitted by the Food and Drug Administration in March, 1998.This works through boosting the effects of the nitric acid, a chemical that plays the role of relaxing muscles within the penis during sexual stimulation hence increased blood flow. Culley (2004) adds that other oral medicine may before long be in existence to deal with ED cases.Vardenafil and Cialis, for instance are under examination for their safety as well as their effectiveness. They all work in the same manner as Viagra. According to research carried out by Geneva Foundation for Medical Education and Research (2007), a good number of men attain appropriate erections through drug injections applied directly on the penis, allowing it to be bloated with blood. Other drugs including alprostadil, papaverine hydrochloride, as well as phentolamine broaden the blood vessels. These drugs have however their side effects including constant erection.Research on drugs usage for treating ED is growing quickly and patients ought to ask their physicians about the most up-to-date progresses (Geneva Foundation for Medical Education and Research (2007). Surgery involves establishing a device that enables the penis to be erect, restructuring the arteries to enhance blood flow into the penis as well as jamming off the veins to enable blood pour out from the penile tissues. Culley (2004) notes that the established devices are able get erection back to normal amongst many men having the ED problem. Probable problems with these devices include mechanical damages as well as infections which have however gone down due to technological progress. The devices are made up of rods, which are surgically put into the corpora cavernous. The patient then manually regulates the position of his penis. Recommendations Lifestyle transformations as well as risk factors alteration ought to come first in the erectile dysfunction disorders. Treatments in favor of the erectile problems ought to be considered at the earliest stages when detected by the patients and appropriate measures taken to visit medical practitioners. Treatment should be carried out immediately after a thorough prostatectomy. If it has been discovered that it is treatable, the cause of erectile dysfunction is identified. The cause ought to be treated as an urgent priority. As a result of the inconclusive proofs on the efficiency of hormonal therapy for patients with lower levels of testosterone, medical doctors ought to find out the presence or absence of signs of hormonal dysfunction including low libido, untimely ejaculation, tiredness, and other associated problems such as testicular weakening. People with diabetes can also employ the use of medications such as the use of Viagra, Levitra as well as Cialis to treat erectile dysfunction disorders. This facilitates proper erectile function allowing an individual to maintain erection during sexual intercourse (Giugliano et al., 2010). The medications can be between duration of half an hour before sex and the results can go on for 4 to 5 hours. It is also recommended that medical doctors initiate therapy through the use of a PDE-5 inhibitor in men looking for treatment for erectile problems. This ought to be only those patients with no problem with the use of the inhibitor. All the methods described are all effective in the treatment of the disease, variations are only found on physicians’ prescriptions as well as the patients’ preferences. Conclusion Erectile Dysfunction is a widespread disorder of diabetes and has diverse effects on the victim’s quality of life. It is also evident from various reviews that it is composed of a strong organic component and since men with this complication value the erectile function so much, it is crucial that the health providers insist that the victims maintain good glycermic, blood pressure, as well as lipid to reduce the risk of such disorders. For diabetic victims with such complications, it is crucial that they be aware of many useful therapies available. Health providers should also be able to make inquiries on the complications when conducting treatments on their diabetic patients in addition to giving them appropriate treatments. Progresses in medications, implants, as well as vacuum erection devices have increased various options for patients looking for treatments towards ED.These progresses have consequently led to the increase in the number of patients in search of treatment. Gene therapy meant for ED treatment is currently being examined in many centers which may eventually offer a long lasting therapeutic approach towards ED. Bibliography Barclay, L, 2009, ACP Issues Guidelines for Treatment of Erectile Dysfunction, Ann Intern Med. Retrieved August 14, 2010 from Culley, C.C, 2004, Pyschosomatic Medicine, Erectile Dysfunction: Evaluation and New Treatment Options, Journal of Biobehavioral Medicine, University of North California, California., Retrieved August 22, 2010 from Geneva Foundation for Medical Education and Research, 2007, Hormonal testing and pharmacologic treatment of erectile dysfunction: A clinical practice guideline from the American College of Physicians, GFMER publications. Giugliano, F, Maiorino, M, Bellastell, G, Gicchino and Esposito, K, 2010, Determinants of Erectile Dysfunction in Type 2 Diabetes, International Journal of Impotence Research (2010) 22, 204–209, Retrieved August 22, 2010 from Jonas, U, Thon, W.F, Stief, C, G and Abicht, J, H, 1991, Erectile Dysfunction, Springer-Verlag. Manzella, D, 2008, Diabetes and Erectile Dysfunction: Complications of Diabetes-Erectile Dysfunction Retrieved August 22, 2010 from Morales, A.M, Mirone, Vincenzo and Dean, J, 2009, Vardenafil for the Treatment of Erectile Dysfunction: An Overview of the Clinical Evidence Published Date December 2009; Volume 2009:4 Pages 463 – 472, Retrieved August 14, 2010 from The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), 2005, Erectile Dysfunction, Retrieved August 22, 2010 from http National Diabetes Information Clearinghouse (NDIC), 2008, Sexual and Urologic Problems of Diabetes, NIH Publication, Retrieved August 22, 2010 from Penson, D.F and Wessells, H, 2004, Erectile Dysfunction in Diabetic Patients, Diabetic Spectrum. Retrieved August 22, 2010 from Read More