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Introduction
• Diabetes mellitus (OM) is a global epidemic causing a number of complications,
one of them being sexual dysfunction in males and females
• A threefold increased risk of erectile dysfunction (ED) has been documented in
diabetic men, compared to non-diabetic men
• Female sexual dysfunction appears to be more related to social and
psychological components than that of the physiological consequence of
diabetes
• Conception and pregnancy is not easy for diabetic women
• Sexual dysfunction due to diabetes often receives less attention than it deserves
• Sex is generally considered as a taboo subject and is perceived as a sin
EPIDEMIOLOGY
• It has been observed that approximately 35-75% of Indian diabetic men
suffer from ED as compared to 26% of the general population
• In addition, diabetic men sufferfrom ED 10-1 5 years early in their Iif~
compared to their normal counterparts
• Premature ejaculation (PE) was likely to be associated with longer (> 10
years) duration of diabetes, poor metabolic control and concomitant
cardiovascular disease (CVD)
• It is seen that approximately 70% of diabetic women have certain degree
of sexual dysfunction. Sexual dysfunction is associated with higher age,
clinical depression and one or more diabetes-related complications
BARRIERS TO THE DIAGNOSIS OF SEXUAL
PROBLEMS IN INDIA
PHYSICIAN RELATED BARRIERS
• The main difference between eliciting ordinary medical history
and sexual history is that the doctor is embarrassed and
uncomfortable asking questions to the patient about their sexual
life
• In India, doctors may find it difficult to discuss the sexual process,
any related misconceptions expectations and correct unrealistic
• Physicians may lack the expertise to handle sexual problems
BARRIERS TO THE DIAGNOSIS OF SEXUAL
PROBLEMS IN INDIA
PHYSICIAN RELATED BARRIERS
• Considering the Indian diversity, doctors do not use regional terms/language
for easy understanding of the patient e.g., local terminologies for sexual organs,
activities, etc.
• Doctors may not know what questions to ask or how to ask them, they may feel
uncomfortable with the topic, awkward using sexual terms and fear of insulting
the patient
• Some physicians may believe that sexual history is not relevant to the chief
complaint of the patient
• Some physicians may remark that they do not have the time to address these
concerns
BARRIERS TO THE DIAGNOSIS OF SEXUAL
PROBLEMS IN INDIA
PATIENT-RELATED BARRIERS
• Indian patients are often shy, feel uncomfortable discussing sexual
complaints and may overcome the feeling of guilt and shame. Often,
there is a stigma attached to seeking sexual consultation
• Indian patients are reluctant to discuss sexual problems with their
doctors and for those who are willing, they may not be sure whom to
approach
• There are a number of myths and superstitions around sexual problems
BARRIERS TO THE DIAGNOSIS OF SEXUAL
PROBLEMS IN INDIA
PATIENT-RELATED BARRIERS
• Due to the stigma attached, patients try to often hide their problems
and find ways to cope with them
• Sexual problems in men have an underlining chauvinistic attitude and
feel that it is an assault to their masculinity
• Patients are unaware of the effects of drugs and are often scared to take
them
• In India, sex education is a neglected entity and many do not feel the
need to educate their children regarding it
SEXUAL COMPLICATIONS OF DIABETES
MELLITUS IN MEN
SEXUAL COMPLICATIONS OF DIABETES
MELLITUS IN MEN
Pathogenesis
Pathogenesis
DIAGNOSIS
History taking
• Comprehensive history taking is essential for the diagnosis of ED.
It is important to elicit the following information regarding ED
Onset and progression of ED
– ED with a sudden onset, intermittent course, or short-duration may be due
to psychogenic factors. The presence of rigid morning or night erections, or
rigid erections at any sexual thought mainly suggests a psychogenic cause
– Conversely, ED with a gradual onset, progressive course, or long duration
suggests a predominantly organic cause such as diabetes, alcohol or
tobacco consumption
DIAGNOSIS
Predisposing factors and medications
•
DM
•
Illicit drug abuse
•
Peyronie's disease
•
Past penile or prostate surgery
•
Alcohol
•
Antidepressants, Antihypertensives
•
Tobacco
(hydrochlorothiazide), Antihistamines and
Tranquilizer
Relationship issues and any psychological problems
•
A detailed psychosocial history of the patient, including patient's assessment of his
own sexual performance, patient's general attitude, and knowledge about sex may
help rule out complex psychological problems
PATIENT EXAMINATION
PATIENT EXAMINATION
When to refer to specialist?
MANAGEMENT
Medical therapy
• Oral PDE5-1 are used as the first-line treatment for ED
• They inhibit PDE-5 enzyme that normally degrades cyclic
guanosine monophosphate (cGMP) in the cavernous smooth
muscles
• This leads to prolonged activity of cGMP, which decreases the
intracellular calcium concentrations, maintains smooth muscle
relaxation and results in rigid penile erections
Medical therapy
Surgical Therapies
Surgical Therapies
Surgical Therapies
Other alternatives
• Intracavernosal injection and transurethral therapy
• Vacuum constrictive devices
• Phyto-neutraceuticals combined with L- arginine and
antioxidants
• Stem-cell therapy
• Gene therapy
PREVENTION AND DIABETES CONTROL
• ED due to diabetes, especially T1 DM can be reversible provided hyperglycaemia
is controlled through lifestyle modifications-exercise and diet, avoidance of
smoking and appropriate use of oral hypoglycaemic agents and/or insulin
• Kegel exercises also help to correct PE
• Physical exercise and weight reduction can improve erectile function by
decreasing endothelial dysfunction, insulin resistance and the low-grade
inflammatory state already associated with diabetes and metabolic dysfunction
• Additionally, in order to treat the patient's comorbidities, medications with the
least adverse impact on erectile function should be sought e.g.,
antihypertensives and antidepressants
PREVENTION AND DIABETES CONTROL
The medications that can cause ED are
• Diuretics
• Muscle relaxants
• Antihypertensives
• Nonsteroidal anti-inflammatory drugs
• Antihistamines
• Histamine H2-receptor antagonists
• Antidepressants
• Hormones
• Parkinson's disease drugs • Chemotherapy medications
• Tranquilizers
• Prostate cancer drugs
• Anti-seizure medications
COUNSELLING STRATEGIES- THE MAINSTAY OF
MANAGEMENT
• The counselling session should begin with an open-ended question
e.g., what changes have you noticed? followed by a statement that
It is common for men with diabetes to have sexual problems then further
targeting patients age, medications, risk factors, lifestyle, etc.
• Patients may have numerous doubts and queries related to the use of
medication prescribed
• These concerns need to be addressed at first
• ED or sexual dysfunction of any form affects not only the patient, but
also his partner. The partner may believe that ED indicates either a lack
of affection or transfer of sexual relations elsewhere
COUNSELLING STRATEGIES- THE MAINSTAY OF
MANAGEMENT
• Where possible, couples should be welcomed to each consultation and
should be offered psychosexual counselling along with any other
intervention which is prescribed
• It is important for the partner of an ED patient to talk to him about the
problem. The care and concern of a partner is often the reason a man
seeks medical advice and counselling
• Partners can give valuable support throughout the treatment process.
This can be useful in helping couples to re-establish a sexual
relationship, even when there has been a lengthy period without
sexual activity because of ED
COUNSELLING STRATEGIES- THE MAINSTAY OF
MANAGEMENT
• Understanding the causes and the way the treatment of ED
works this can help partners cope with their personal problems
which they may suffer as a result of the ED
• Along with the treatment it is very helpful for a partner to
understand that sexual stimulation is still needed for an erection
to happen
• Review of accomplishments should be done at every follow-up
session
Models that can be used to assess sexual function
Evaluation
Evaluation
SEXUAL COMPLICATIONS OF DIABETES
MELLITUS IN WOMEN
SEXUAL COMPLICATIONS OF DIABETES
MELLITUS IN WOMEN
CLINICAL MANIFESTATIONS
DM and Menstrual Cycle
PATHOGENESIS OF SEXUAL COMPLICATIONS IN
WOMEN WITH DM
PATHOGENESIS OF SEXUAL COMPLICATIONS IN
WOMEN WITH DM
PATHOGENESIS OF SEXUAL COMPLICATIONS IN
WOMEN WITH DM
• To identify whether a diabetic woman has sexual dysfunction and
to prescribe an appropriate treatment, the physician should
identify the factors that contribute to sexual dysfunction
• One must assess the woman's current interpersonal and
psychosocial status, her sexual and medical history, comorbid
illness as well as her medications
Medical history should be obtained especially
pertaining to
• Duration of diabetes
• Glycaemic control
• Symptoms or signs of
depression
• Presence or absence of chronic • Comorbid medical conditions
diabetes complications
• Pharmacologic treatment of
diabetes
• Episodes of hypoglycaemia
• Surgical history
• Medications other than
antibiotics for diabetes
• Menopausal status
Medical history should be obtained especially
pertaining to
• Personal habits such as
smoking, alcohol intake,
• Regularity and duration of
menstrual cycle
duration and type of exercise • Menstrual flow
• Gynaecologic history and
history of sexual function
• Age of menarche
• Fertility in terms of time
required to achieve
conception, miscarriages, and
pregnancy outcomes
When to Refer to specialist?
Management
Management
Management
Counselling
MENSTRUATION, PREGNANCY, MENOPAUSE
AND DIABETES
MENSTRUATION, PREGNANCY, MENOPAUSE
AND DIABETES
MENSTRUATION, PREGNANCY, MENOPAUSE
AND DIABETES
MENSTRUATION, PREGNANCY, MENOPAUSE
AND DIABETES
MENSTRUATION, PREGNANCY, MENOPAUSE
AND DIABETES
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