title: Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido.
abstract: BACKGROUND
  Among men with diabetes, little attention has been given to premature ejaculation (PE), reduced libido, and their associations with erectile dysfunction (ED), despite the presence of physical and psychologic factors that could predispose to all three.
  
  
  OBJECTIVE
  To estimate the prevalence and inter-associations of ED, PE, and reduced libido among diabetic men and to describe the associated clinical, socioeconomic, and lifestyle parameters.
  
  
  METHODS
  Cross-sectional observational study of 253 men with type 2 diabetes randomly selected from a clinic in Colombo, Sri Lanka.
  
  
  METHODS
  Erectile function was assessed using the five-item version of the International Index of Erectile Function scale. The presence of PE, reduced libido, sociodemographic, and lifestyle data was obtained using an interviewer-administered questionnaire. Clinical data were obtained from relevant physical examination, patient records, and laboratory tests, which included glycosylated hemoglobin, serum cholesterol, serum creatinine, and electrocardiogram.
  
  
  RESULTS
  One hundred and eighty-five (73.1%) of the individuals had some degree of ED, while 84 (33.2%) had severe to complete ED. After excluding men with complete ED, the prevalence of PE was 68 (40.2%). The overall prevalence of reduced libido was 64 (25%). In the multivariate analysis, the strongest associations with ED were PE (odds ratio [OR] = 4.41, 95% confidence interval [CI] = 2.08-9.39) and reduced libido (OR = 4.38, CI = 1.39-13.82) followed by lower income (OR = 2.16, CI = 1.32-3.52), advancing age (OR = 2.06, CI = 1.44-2.95), and duration of diabetes (OR = 1.48, CI = 1.09-2.01). In addition, ED was univariately associated with lower educational level (P = 0.05), the presence of hypertension (P = 0.005), and no alcohol intake (P = 0.001). The only significant association of PE was the severity grade of ED. Associations of reduced libido in the multivariate analysis were ED (OR=1.61, CI = 1.23-2.70), advancing age (OR = 1.7, CI = 1.4-2.2), and absence of masturbation (OR = 3.3, CI = 1.2-8.8).
  
  
  CONCLUSIONS
  ED was strongly associated with PE and reduced libido. Diabetic patients presenting with one of these three conditions should be screened for the other two.
authors.affiliation: University of Oxford, Nuffield Department of Clinical Medicine, Oxford, UK. lasantha.malavige@ocdem.ox.ac.uk
authors.forename: Lasantha S
authors.initials: LS
authors.lastname: Malavige
authors.forename: Shanthilal D
authors.initials: SD
authors.lastname: Jayaratne
authors.forename: Samudra T
authors.initials: ST
authors.lastname: Kathriarachchi
authors.forename: Sivagurunathan
authors.initials: S
authors.lastname: Sivayogan
authors.forename: Devaka J
authors.initials: DJ
authors.lastname: Fernando
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D004542:Ejaculation; D007172:Erectile Dysfunction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007989:Libido; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human