title: Diabetes and Sexuality.
abstract: BACKGROUND
  Deterioration in sexual functioning is one of the major and serious complications of diabetes. This common metabolic disorder not only affects sexuality through microvascular and nerve damage but also has psychological aspects. In men, the primary complications are erectile dysfunction, ejaculatory dysfunction, and loss of libido. Women similarly experience sexual problems, including decreased libido and painful intercourse.
  
  
  OBJECTIVE
  To summarize the effects of diabetes on sexuality, evaluate the impact of diabetes on sexual function, and assess the conventional and novel treatment approaches based on recent studies.
  
  
  METHODS
  A literature review of peer-reviewed journal articles and guidelines was performed.
  
  
  METHODS
  To assess the effects of diabetes on sexuality and to focus on treatment approaches.
  
  
  RESULTS
  Male and female sexual dysfunctions are a significant complication of diabetes. Tight glycemic control seems to be beneficial in delaying the onset of sexual problems and ameliorating them when they are present. Erectile dysfunction occurs as one of the first problems. The current mainstay of treatment for erectile dysfunction is therapy with phosphodiesterase type 5 inhibitors and then a stepwise approach of management. Men also can experience ejaculation problems and loss of libido. Diabetes also can decrease testosterone levels, which further decreases libido. Hypogonadal men with diabetes might benefit from testosterone replacement therapy. Diabetic women also can have sexual problems. These problems mainly include loss of libido, decrease in arousal and lubrication resulting in painful intercourse, and loss of orgasm. All these challenges require a multidisciplinary approach.
  
  
  CONCLUSIONS
  Diabetes has detrimental effects on the sexual function of patients. Diabetologists who primarily care for the patient should not only focus on the glycemic control of their patients but also address their sexual complaints, because these problems can significantly impair their quality of life. Urologists, gynecologists, endocrinologists, and psychiatrists should work in a multidisciplinary manner for the treatment of decreased sexual functioning as a result of diabetes.
authors.affiliation: Department of Urology, Turgutlu State Hospital, Manisa, Turkey.
authors.forename: Fuat
authors.initials: F
authors.lastname: Kizilay
authors.affiliation: University of California-San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Helena Elizabeth
authors.initials: HE
authors.lastname: Gali
authors.affiliation: Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey. Electronic address: egecanserefoglu@hotmail.com.
authors.forename: Ege Can
authors.initials: EC
authors.lastname: Serefoglu
keywords: Complications; Diabetes; Ejaculatory Disorder; Erectile Dysfunction; Libido; Quality of Life; Sexual Dysfunction; Testosterone