Erectile dysfunction: does insulin resistance play a part?
OBJECTIVE
To review MEDLINE literature for correlations between insulin resistance and erectile dysfunction (ED).


METHODS
MEDLINE literature review (1966 to present).


METHODS
Academic medical center.


METHODS
None.


METHODS
None.


METHODS
None.


RESULTS
Erectile dysfunction affects more than half of men over the age of 40. Fortunately, most men with ED can be successfully treated with phosphodiesterase 5A (PDE-5) inhibitors, which up-regulate the vasodilatory effects of nitric oxide (NO). Insulin resistance affects 25% of U.S. adults and increases to a 60% occurrence in individuals who are overweight. Endothelial dysfunction, which is associated with insulin resistance states, can cause disturbances in the subcellular signaling pathways required for NO production. Because endothelial production of NO and insulin sensitivity are positively related in healthy humans, the relationships among insulin resistance, NO, and ED are the target of this review of MEDLINE literature.


CONCLUSIONS
Insulin resistance states are characterized by defective vascular NO production and impaired insulin-induced vasodilation, both of which are likely to cause ED. Diagnosing and treating insulin resistance should be part of the initial management plan for ED. Future studies concerning the cause and effect relationship of insulin resistance and ED should be implemented.
Trussell
J C
JC
Division of Urology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, PA 17033-0850, USA. jtrussell@psu.edu
Legro
Richard S
RS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000818:Animals; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology*; D012739:Gonadal Steroid Hormones / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000502:physiology; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000502:physiology; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors / Q000502:physiology; D019869:Phosphatidylinositol 3-Kinases / Q000378:metabolism; D051057:Proto-Oncogene Proteins c-akt / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D012739:Gonadal Steroid Hormones; D007328:Insulin; D009569:Nitric Oxide; D019001:Nitric Oxide Synthase; D019869:Phosphatidylinositol 3-Kinases; D051057:Proto-Oncogene Proteins c-akt