ERECTILE DYSFUNCTION 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

ERECTILE DYSFUNCTION  Erectile dysfunction (ED) affects approximately 34 to 45% of men with diabetes.  Risk factors include increasing age, increasing duration of diabetes, poor glycemic control, smoking, hypertension, dyslipidemia and cardiovascular disease.  Psychological and situational factors may also cause or contribute to erectile dysfunction.

SCREENING  Screening for ED with a sexual function history should be performed on all adult men with diabetes at diagnosis and periodically thereafter.

TREATMENT  While no randomized trial has demonstrated that interventions that improve glycemic control also reduce the incidence or progression of ED, both the DCCT and UKPDS showed that intensive glycemic control was effective for the primary prevention of and secondary intervention for neuropathy.  Type 5 phosphodiesterase (PDE5) inhibitors can be used to treat ED and should be offered as first-line therapy to men with diabetes wishing treatment. PDE5 inhibitors are contraindicated if the man has unstable angina, poor exercise tolerance or uses any form of nitrate medication.

ERECTILE DYSFUNCTION - RECOMMENDATIONS  All adult men with diabetes should be periodically screened for ED with a sexual function history. Screening for ED in men with type 2 diabetes should begin at diagnosis of diabetes [Grade D, Consensus].  A PDE5 inhibitor should be offered as first-line therapy to men with diabetes with ED wishing treatment if there are no contraindications to its use [Grade A, Level 1A].  Referral to a specialist in ED should be considered for men who do not respond to PDE5 inhibitors of for whom the use of PDE5 inhibitors is contraindicated [Grade D, Consensus].