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Studies of ED suggest that it’s prevalence in men with diabetes ranges from 45-85% versus 26% in general male population. The natural history of ED in people with diabetes is normally gradual and does not occur overnight. The onset of ED also occurs 10–15 years earlier in men with diabetes than it does in sex-matched counterparts without diabetes. Both vascular and neurological mechanisms are most commonly involved in people with diabetes. Atherosclerosis in the penile and pudendal arteries limits the blood flow into the corpus cavernosum. Because of the loss of compliance in the cavernous trabeculae, the venous flow is also lost. This loss of flow results in the inability of the corpora cavernosae to expand and compress the outflow vessels.
Autonomic neuropathy is a major contributor to the high incidence of ED in people with diabetes. Norepinephrine- and acetylcholine-positive fibers in the corpus cavernosum have also been shown to be reduced in people with diabetes. This results in loss of the autonomic nerve–mediated muscle relaxation that is essential for erections.
Sildenafil (Viagra) acts by blocking the catabolism of cGMP, resulting in an increase in nitric oxide. Less than Thirty-six percent of diabetic men with ED experience improvement with sildenafil, compared to 70% of nondiabetic men with ED. Side effects of sildenafil are similar to those from taking niacin or any vasodilator, namely, headaches, lightheadedness, dizziness, and flushing. Some individuals experience a bluish tinge of their cornea, which makes them feel as if they are wearing light blue–tinted sunglasses. This effect can last for several hours
For those patients who are not candidates for oral therapy, intracavernosal injections are an acceptable alternative. Injections with Trimix have been used to induce erection. This form of therapy has a response rate of well over 90%. The sympathetic nervous system normally maintains the penis in a flaccid or non-erect state. All of the vasoactive drugs, when injected into the corpora cavernosae, inhibit or override sympathetic inhibition to encourage relaxation of the smooth muscle trabeculae. The rush of blood engorges the penile corpora cavernosae sinusoidal spaces and creates a full long lasting erection.
At the Oklahoma Men’s Clinic, our physicians will check all your medications, medical history, any surgeries or conditions you have or have had, do an ultrasound to the penis to check your blood flow consideration, provide a BMI (Body Mass Index), do a blood work up, and render you the best educated opinion of what will work best for you. Be assured that you will get the our best advice and medical recommendations. At Oklahoma Men’s Clinic we have achieved over a 90% success rate in men with Diabetes.