title: Erectile dysfunction and diabetes: a review of the current evidence-based medicine and a synthesis of the main available therapies.
abstract: OBJECTIVE
  This review aimed to provide an update of the epidemiology, pathophysiology and management of erectile dysfunction (ED) in diabetes patients.
  
  
  METHODS
  Data on the management of ED in diabetes patients in the literature were analyzed using Medline, and by matching the following keywords: diabetes; erectile dysfunction; endothelial dysfunction; cardiovascular disease; phosphodiesterase inhibitors; intracavernous injection; and penile prosthesis.
  
  
  RESULTS
  ED has a higher incidence in diabetic patients. The pathophysiology is multifactorial, involving endothelial dysfunction, specific complications of diabetes and psychological factors. Recent studies have shown that ED is able to predict future cardiovascular events not only in non-diabetics, but also in patients with diabetes. ED could also be a potential marker to screen for silent coronary artery disease. The management of ED has been revolutionized by the discovery of phosphodiesterase type-5 (PDE5) inhibitors, the first-line therapeutic options for diabetic men with ED that are efficient and safe. As a second line, intracavernous injections remain a gold-standard treatment, although a vacuum device can be used as well. In cases of failure, penile prosthesis may be considered. Hypogonadism, commonly found in diabetics, may require identification and treatment. Optimalized glycaemic control, management of associated co-morbidities and lifestyle modifications are essential in all patients. As ED and diabetes negatively impact male self-esteem, and generate depression and anxiety, the psychological treatment of patients is also likely to be beneficial.
  
  
  CONCLUSIONS
  The aetiology of diabetic ED is multifactorial. Endothelial dysfunction is the link between diabetes-induced ED and coronary artery disease. A global approach is needed for the successful management of diabetic ED.
authors: Urology and Andrology Academic Department of Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre-et-Marie-Curie, University Paris-VI, Paris, France.
authors: V
authors: V
authors: Phé
authors: M
authors: M
authors: Rouprêt
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000188:drug therapy; D048909:Diabetes Complications / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D016540:Smoking Cessation
chemical_list: D058986:Phosphodiesterase 5 Inhibitors