Erectile dysfunction and associated factors among men with diabetes mellitus from a tertiary diabetic center in Northern Sri Lanka

Erectile dysfunction and associated factors among men with diabetes mellitus from a tertiary diabetic center in Northern Sri Lanka

Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows). They show beneficial control especially in young active hypertensives. Seismic imaging technology could deliver finely detailed images of the human brain. Can high blood pressure affect sexual functioning? 005); BMI > 25 (P = 0. Do not stop taking your medicines without speaking to your doctor first. This widely accepted tool evaluates five aspects of sexual function such as erectile function, orgasm, desire for sex, satisfaction after intercourse and overall satisfaction.

Even a single episode of erectile dysfunction can cause anxiety. Initial efforts should identify and treat all modifiable risk factors. While many drugs used to treat high blood pressure have been linked to erectile dysfunction, some are much less likely than others to cause problems.

  • Some beta blockers bind to many different type of beta-receptors and can often block those receptors(beta-2).
  • His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.
  • The recommendation to switch patients with erectile dysfunction who require ongoing beta-blocker treatment to carvedilol is based on pharmacological theory.
  • In an individual aspect, sexual activity and erectile function quality should be part of anamnesis before starting antihypertensive therapy and seems to play a relevant role in the followup, as it would allow a scalable monitoring of erectile function, help the selection of better classes of antihypertensive drugs, turn easier the identification of adverse sexual events, and even improve therapeutic compliance [51].
  • It's known that diuretics (or water pills, like hydrochlorothiazide) and beta-blockers (like Atenolol) can also cause erection problems.
  • A physical cause can be identified in about 80% of cases.
  • Another theory proposed is the digoxin-associated inhibition of the corpus cavernosum smooth muscle sodium pump activity, which promotes corporeal contraction and impedes nitric oxide induced relaxation, leading to ED [41].

2 Cavernosal artery by grayscale bi-dimensional ultrasound. If you and your healthcare provider decide to take that approach to treat medically induced ED, it’s worth noting the main differences between ED medications. Keto cheat day: should you have them on a ketogenic diet? Some of the common causes of low libido are low testosterone, low estrogen, lack of self-confidence and self-esteem, excess alcohol, stress, and depression. 3 percent to 58.

5 Cavernosal artery flow by spectral pulsed duplex before initiation of treatment by atenolol. ED is the most common sexual dysfunction, and many guys experience it at some point in their lives. Importantly, the heart conditions should be carefully clarified before initiation of medical treatment, as PDE5 inhibitors must not be used in certain cardiovascular conditions or at least require special precaution. In the few studies concerning sexual function in female patients with antihypertensive treatment, metoprolol seems to negatively affect female sexual function index scores (FSFI) [16], especially in comparison with ARBs which seem to ameliorate FSFI scores [17, 18]. If you remember that you have missed a dose of Lopressor, take it as soon as possible. However this study failed to show an association with smoking (P-0. )Some over-the-counter antihistamines and decongestants can cause erectile dysfunction or problems with ejaculation. Some patients develop orthostatic hypotension when PDE5 inhibitors are used in conjunction with an alphablocker (typically for urologic conditions, such as benign prostatic hypertrophy) but some studies suggest that the interaction is less clinically relevant if the patient has been undergoing long-term alpha-blocker therapy [81].

That might include erections that don’t last as long as you want or aren’t as firm as you’d like.

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A small number of patients and inadequate evaluation of erectile function limit the trials results. But the results are controversial in some other studies [12, 14]. It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months. "Data collected for a period of 5 months from August 2020. Smaller studies pointed to hydrochlorothiazide and chlortalidone causing loss of libido and ED [31, 32]. Those numbers were similar in more recent publications over the world [5] and also in developing countries [6], projecting the assumption that over 30 million American citizens suffer from some level of sexual dysfunction [5]. Beta blockers are very commonly used as antihypertensive medications in young active individuals.

Compared to the general population, hypertensive patients have a higher prevalence of ED (3,4). Besides this high prevalence, before oral therapy with phosphodiesterase-5 (PDE5) inhibitors, less than of men with ED search for medical help [7]. Two exciting new potential uses for viagra, the good news is that quitting smoking can improve your health (and your erection) almost immediately. What causes ed? Such symptoms are characteristic of a more mature generation. The problem is fairly common. There was also a significant decrease of the stimulated EDV with nebivolol (0. )

An adequate approach to identify sexual health in primary care is needed to identify sexual dysfunctions earlier and also to individualize treatment, to prevent that this situation contributes to a reduction of therapeutic adhesion and even worsens the quality of life among people who already suffer from AH and other traditional risk factors.


Therefore, it is unlikely that choosing a different type of beta-blocker, i. A study of 82 men with sexual dysfunction, published in the May 2020 issue of the American Journal of Medicine and Science, found that patients had more reliable erections and more frequent sex after treatment with the drug losartan (Cozaar). Amy fox, the arteries surrounding the genital area are narrower than coronary blood vessels, so they're more susceptible to clots. The increase of ED’s prevalence with aging is followed by atherosclerotic lesions in vascular tree [18].

These clinical manifestations rarely are symmetrical in the same patient, probably due to different sizes of arterial tree that irrigate territories such as penile, heart, brain, and legs [20], and different needs of blood supply and vasodilation of each structure [67]. Steamed vegetables, low testosterone levels can also affect your sex drive and sperm production, which means that it can affect more than just your interest in sex—it can also affect your fertility. It is well known that the blood increment towards cavernous tissues necessary for a rigid erection is huge and even small hemodynamic disturbances could produce sexual dysfunction [22]. What causes erection problems in one man may not affect another man. There are likely good reasons you were prescribed your original medication in the first place. What is medically-induced ED? They found that vasodilation of the brachial artery by both mechanisms, endothelium-dependent and independent, was significantly compromised in the group suffering from ED, which illustrates that vascular alterations involved in ED are a generalized process [67]. 5 ways to boost bone strength early, however, it isn't clear whether vision or hearing loss was directly caused by taking the medication or by a preexisting condition. High blood pressure can increase a man's risk for erectile dysfunction, yet some BP drugs also can contribute to the problem.

Blood Pressure Medications and ED

And, in rare cases, the extra exertion could trigger a heart attack. Site information & policies, the real-life safety and efficacy of vardenafil (REALISE) study:. A study of 640 women, published in the June 2020 issue of The American Journal of Hypertension, found that the women with hypertension were significantly more likely than others to suffer pain during intercourse. Psychological impotence is where erection or penetration fails due to thoughts or feelings; this is somewhat less frequent, on the order of about 10% of cases. (5%), but only 9. What are other alternatives? High blood pressure often has no signs or symptoms. Has your relationship with your sexual partner changed recently? Please click "Confirm" if you are happy to lose these search results.

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Over the last few weeks I have spoken to one of the cardiologists who suggested switching those who need to stay on a beta-blocker to carvedilol as it is more cardioselective. Taking medicines properly is one of the surest ways to cut down on side effects, sexual or otherwise. In contrast, in other more recent trials no significant adverse effects on sexual function were found with metoprolol [12], propranolol [13], acebutulol [14] and atenolol [15]. The UFHSC-J is a clinical teaching site for the Gainesville-based College of Nursing.

You might have an adverse reaction to a particular medication, or an alternative is unavailable in your state, health insurance plan, or your budget. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram. The TOMHS trial showed a significant decrease in sexual activity rate through 24 months in men taking enalapril, compared with placebo [30]. 5 % in the placebo group. However, considering the strong correlation and pathophysiological link between endothelial and erectile function, beta-blockers with beneficial effects on nitric oxide synthase and oxidative stress can improve erectile function [27]. Whatever you choose, always make sure that your blood pressure is in line and in a safe range. The net effect of α-adrenergic antagonists on erectile function is likely to depend on the balance between pro-erectile effects in the brain and the penis and anti-erectile effects as a result of blood pressure lowering mechanisms.

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High blood pressure medications that can cause sexual dysfunction as a side effect include: Experimental studies have demonstrated an enhancement of endothelial function in aorta and corpus cavernosum with a significant reduction in penile oxidative stress and collagen content [49], protected cavernosal tissue against structural changes, and increased expression of endothelial NO synthase (eNOS) [50]. Weiss RJ et al. Effect of ldl on erection:, treating atherosclerosis with statins may, therefore, lead to a decrease in ED symptoms. All the duplex examinations were performed with (ALPINION E-CUBE 9, Seoul, Korea) ultrasound machine using a 7 MHz linear phased array transducer. Erectile function preservation is essential for sexually active man while having a lower weight for other who has no intercourses.

Erection is a complex psiconeurovascular process and involves several system interactions that converge to an increase in hypogastrian-penian blood flow and subsequent activation of veno-occlusive mechanism of corpus cavernosum [21]. Brinkley initiated a boom in male impotence cures in the U. Although no class of antihypertensive agents presents a clearly superior effect over the others in terms of quality of life, the current impression is that nebivolol, ACE inhibitors, and angiotensin II receptor antagonists may offer some advantage, at least in regard to effects on cognitive function and sexual activity [51]. If the patient experiences ED due to the propranolol, we can see if he experiences the same benefit from Topamax, which is also used to prevent migraines and isn’t generally associated with ED. The other piece of advice my friendly cardiologist gave me was post-MI, if they can walk up two flights of stairs Viagra was fine; again, not what I had been led to believe historically. They confirmed ED as a clinical independent marker of increased cerebral vascular disease risk [65]. A survey of 104 men with hypertension, published in the October 2020 issue of The Journal of Urology, found that the vast majority -- 71 patients -- had some form of erectile dysfunction. Thus, one possible mechanism by which hypertension may cause ED is likely related to endothelial dysfunction associated with hypertension.

  • In high risk subjects, cardiologic condition should be stabilized through medication, surgery, or other means before sexual rehabilitation.
  • Sexual health and an active sex life are integral parts of your health and wellness.
  • 0378-603X © 2020 The Authors.
  • FSF will be assessed with the above questionnaires-FSFI and CSFQ.
  • Taking testosterone may help maintain an erection.
  • A complicating factor is that some of the medications used to treat cardiovascular risk factors have erectile dysfunction as a side effect.
  • Will switching from metoprolol to carvedilol improve the patient’s symptoms?

Review Date 1/31/2020

During COBRA (PolarCath Cryoplasty Versus Conventional Balloon Postdilation of Nitinol Stents for Peripheral Vascular Interventions) trial, Montorsi et al. This may be due to the fact that the age of onset of ischemic stroke and PVD is quite late in this population. 4 tips for coping with an enlarged prostate. We used the Student's paired t-test for analyzing the parametric data and the w2 test for analyzing the categorical data.

There are some controversial results in some studies where increasing age has not been shown to be an independent risk factor for ED in diabetes [14].

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05), and carvedilol (P = 0. If your doctor says it's OK, you may be able to stop taking blood pressure medications temporarily to see if your sex life improves. Having hypertension with the back ground of diabetes significantly increases the risk of arthrosclerosis which might affect the penile arteries [7, 8]. Kloner, MD, PhD, who gave a presentation at the 2020 American Urological Association annual meeting in Washington, DC, is director of research at Heart Institute, Good Samaritan Hospital in Los Angeles. Beta blockers: Metabolic syndrome and waist-to-rip ratio have been associated to more severe ED among those over 50 years old [31]. The following medications might contribute to ED:

Therefore serial HbA1c levels over a period could be an important tool in assessing long term glycemic control and would have a better correlation than a single HbA1C value.

Diuretics and Beta Blockers BP Meds May Cause Erectile Dysfunction

Is there an alternative medicine? Several studies in the 1980s found that ED was a side effect of systemic and topical beta-blocker therapy. This can sometimes cause dizziness. Losartan works by blocking angiotensin, a hormone that causes high blood pressure, and keeping it from binding to body tissues. Propanolol, timolol, and nadolol are non-selective beta blockers and have the most potential for interfering with an erection. The negative effects of beta blockers on sexual function have been recently debated (10,11).

  • Phentolamine (2 mg) is often added.
  • Magnetic resonance angiography (MRA) This is similar to magnetic resonance imaging.
  • The top two medications for high blood pressure associated with ED are diuretics (e.)

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Program completed entirely in Jacksonville. It clearly shows that β-blocker's influence on penile vasculature and, in consequence, on erectile function, needs further investigation. Speak to your healthcare provider about side effects and desired outcomes to see if you can devise a different treatment strategy that works for you.

The connection between both conditions seems to be located in the endothelium, which may become unable to generate the necessary dilatation in penile vascular bed in response to sexual excitement, producing persistent impairment in erection. It could be something as simple as a run away script or learning how to better use E-utilities, http: The sedative and muscle-relaxant properties of benzodiazepines are thought to lessen sexual interest, excitement and sensation. An in vitro study demonstrated statin effects on human testicular testosterone synthesis [67] and in animals effects on the morphology and function of Leydig cells have been seen after statin administration [68]. N Engl J Med 2020;342: Similarly, effects of sildenafil on blood pressure in hypertensive patients on multiple antihypertensive drugs were minimal and well tolerated [79, 80]. Parkinson disease medicines:

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After randomization, subjects are treated for 12 weeks with double blind therapy. A brief list of these medications and brand names include: It can be caused by stress, anxiety or excessive alcohol consumption. The term erectile dysfunction is not used for other disorders of erection, such as priapism. Your doctor can usually solve the problem by simply changing the prescription. A 4-year RCT comparing doxazosin in the treatment of hypertension showed that α-adrenergic antagonists were not associated with ED; it may even improve pre-existing sexual dysfunction [30].

Feldman et al. Medically induced erectile dysfunction is something you (and your healthcare provider) can fix. There is no clinical trial evaluating the effect of calcium channel antagonists on erectile function with an adequate assessment of ED, but they are reported to have no relevant effect on erectile function [47]. High blood pressure's effect on sexual problems in women isn't well-understood. Early studies linked sexual dysfunction to the hormonal alterations observed with digoxin use [42, 43]. Some authors do not agree with a class specific and constant effect over erectile function [45].

Silvestri et al.


Alert about the necessity of sexual excitement to reach an erection under PDE5 inhibitor. The UF College of Veterinary Medicine is Florida's only veterinary college and provides many unique educational programs for students and services aimed at helping pets, wildlife and endangered species. (0%) participants’ diabetic control not up to the mark (HbA1C ≥ 7). Ejaculatory dysfunction is rare with α 1 -adrenergic receptor antagonists that are not selective for the α 1A -adrenergic receptor subtype, namely alfuzosin, doxazosin, and terazosin [39, 40]. Win a copy of baghdad central on dvd, so if things aren't working below the belt, it's absolutely worth seeking medical attention. These include ACE (angiotensin-converting enzyme) inhibitors, calcium channel blockers, alpha blockers and ARBs (angiotensin II receptor blockers). Unfortunately, the theory is not supported by evidence. In countries where men have free access to sexual drugs, the situation of improper use is even more dramatic. To help your doctor select the most appropriate medication for you, tell him or her all the other medications you're taking now — including herbal supplements and over-the-counter drugs.

It is not clear if these differences are caused by the use of other species or can be attributed to other factors. Besides high prevalence of ED among hypertensive individuals, possible association to ED severity and important aspects in therapeutic compliance improvement justify the relevance of a brief sexual anamnesis in one of the first visits inside GP or cardiologists offices [88]. The primary efficacy variable is the change from baseline in Changes in Sexual Functioning Questionnaire (CSFQ) and the Female Sexual Function Index (FSFI). 108 non-smoking, non-diabetic, recently diagnosed hypertensive men, otherwise healthy, participated in the study. Unlike other beta-blockers, which are used to treat high blood pressure, nebivolol (Bystolic) does not cause erectile dysfunction as a side effect. Make sure the medications you or your partner takes are not the reason why you can’t have fun in bed!

All patients underwent an exercise treadmill test to exclude the presence of ischemic coronary artery disease. How is erectile dysfunction treated? The major effect is decreased levels of some sex hormones — estrogen in women and testosterone in men. Here's the good news: Let’s talk about.

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Last but not least, behavioral measures are not very easily interpretable, particularly when there is a combined drug's influence on both arousal and performance. Diuretics are considered one of the most implicated classes regarding sexual dysfunction. Doppler angle was standardized at 59 degrees. Thiazide diuretics and beta-blockers are most likely to cause problems, but this is not a common effect of these medicines and will not happen to everyone. While ED in atherosclerotic rabbit was a consequence of endothelial and vascular smooth muscle cell dysfunctions in consequence of ADMA accumulation [70], these were not found in older animals with ED but without atherosclerosis where possible pathophysiological mechanism would be the hyperactivity of Rho/RhoKinase pathway [57].

In the study, losartan was equal to or better than other drugs at controlling blood pressure. In the 8th century, men of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function. Planned giving, completely impotent:. You might be better off on a medication less likely to cause a problem.

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Safe level of alcohol intake was defined according to the American Heart Association as no more than two standard drinks per day. Still, some people need to be careful. Inform about the time interval to take drug before sexual intercourse. Patient & visitor, selvin E, Burnett AL and Platz EA:. Advertisement, mcMichael say they rarely see side effects in patients taking Propecia, have never seen them persist after discontinuing the drug, and still consider it “safe. Ferrario said losartan may improve sexual function and satisfaction in two ways: Taking these life-saving medications doesn’t have to mean choosing between your health and a healthy sex life.


However, in 1549 cardiovascular high-risk patients included in ONTARGET/TRANSCEND trial, there was neither a beneficial effect of the ACE inhibitor ramipril, the angiotensin receptor blocker telmisartan, nor of the combination of both on erectile function [48]. These endothelial function benefits may rely on the antioxidant effects of statins [77, 78], which clearly predominate over the pro-oxidant effects [79]. Make a difference, treatment is often more successful when a man involves his partner. 10 Penile stimulated EDV in patients before and after initiation of beta-blocker antihypertensive therapy in different groups.

In 3906 men with hypertension alone (no diabetes), ED was present in 67% (defined as a SHIM score of 21) [37]. It is really important to individualize each complain in order to understand the situation and offer the best medical approach. Since α-adrenergic antagonists are first-line therapy for benign prostate hyperplasia (BPH) but only second-line agents for the treatment of hypertension (doxazosin and terazosin), most knowledge regarding sexual adverse effects of α-adrenergic antagonists comes from BPH studies.

Positive impact on patients and their partner quality of life. Production and hosting by Elsevier B. Healthy lifestyle choices include:

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In fact, Viagra slightly lowers the blood pressure – though only for a short time. Men should discuss any concerns with their doctor. When PDE5 inhibitors are administered to patients with hypertension who are taking most antihypertensive agents (e. )Conclusions regarding an association between antihypertensive therapy and sexual dysfunction are limited by the fact that several of the studies denoted in Table III were poorly controlled and results were based on questionnaires. A lower threshold for withholding treatment with a PDE5-inhibitor due to cardiovascular instability is therefore recommended and discussion with a cardiologist is advised if there are concerns. Men considering medications for erectile dysfunction should check with their doctor first. Sexual dysfunction in men with high blood pressure may be aided by the newest type of hypertension drug, reported Carlos Ferrario, M. ACE inhibitors, angiotensin receptor blockers, and calcium channel antagonists were reported to have no relevant or even a positive effect on erectile function [42].

In conclusion, the α-adrenergic antagonists prescribed as second-line antihypertensive treatment do not seem to affect erectile function or ejaculatory function. By making healthy lifestyle choices, you can lower your blood pressure and potentially improve your sex life. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. Therapeutic options for ED easily available and with good efficacy. 79), consuming unsafe level of alcohol (OR = 1. Established in 1923, the College of Pharmacy is the oldest college in the UF Academic Health Center.

In contrast, continuous use of PDE5 inhibitors proved to reverse endothelial dysfunction with positive impact on sexual function and even on blood pressure control. Questions about your health:, patients taking anticoagulants can safely use vacuum constriction devices but need to accept a higher risk of bleeding (ecchymosis). Examples of these are carvedilol and labetalol. The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth.