How common is impotence in diabetic men?
Impotence or erectile failure is one of the commonest complications to affect men with diabetes. It affects approximately 30% of all adult diabetic men and 50% of those over the age of 50 years. Unfortunately this topic was a taboo subject for many years and was not considered part of the care for diabetes patients. It is now recognised that erectile failure can have a serious effect on the quality of life and self-esteem for many men. One of the major goals of diabetes care is to improve quality of life, hence the need to focus more on erectile failure in diabetic men.

How does diabetes affect erectile function?
Erectile function and sexual arousal are dependent upon psychological and physical factors. Diabetes may be associated with many factors that disturb the complex process that allows for sexual arousal and erectile function and these include:
Sensory and autonomic neuropathy
Metabolic abnormalities
Micro and marcovascular disease ejaculatory disorders
Stress, anxiety and depression
Erectile disorders
Other associated disorders like hypertension

Diagnosis
A detailed history and physical examination are required. The man's sexual history should be very detailed, although many men are reluctant to answer some of the questions asked by their doctor. Very few investigations will be needed except to rule out other concomitant disorders.

Treatment
A frank and honest discussion is needed and the man should be fully educated about diabetes and how this will affect erectile function especially if the diabetes is not well controlled. Healthy lifestyles are the foundation of diabetes management. Well-controlled diabetes can decrease the onset of many of the complications associated with diabetes.
Most men with erectile failure do wish to have effective restoration of adequate erectile function sufficient for the resumption of sexual intercourse.
Treatment programmes for erectile failure in diabetic men should try and correct both psychological and physical factors associated with erectile failure. In some men physical treatments have led to restoring erectile function and self-confidence. This has led to the return of spontaneous function in some men with psychological erectile failure. Physical therapy includes the use of intra-cavernosal injection and vacuum tumescence devices. Your doctor will be able to give you more details of these two therapies. Clinical research continues for a simple, safe, effective, non-invasive and unintrusive treatment for erectile failure.

Prevention of diabetes
There is a new emphasis in trying to prevent diabetes from developing in the first place. The increase in the number of individuals with diabetes in the Caribbean is thought to be a result of the rapid cultural changes with the consequent impact on diet and lifestyle. The marked increase in the number of obese individuals and the lack of regular exercise by many of our people today are contributing to the increase in cases of diabetes in Anguilla. Anguillians are being encouraged to adopt healthy lifestyles so that they can prevent certain disorders like diabetes developing.
Many men seldom visit their doctor for a medical check up. In many cases they have diabetes and are not aware of it. Men are being encouraged to visit their family doctor for a check up so that such disorders like diabetes can be detected.

Conclusion
In the past the topic of erectile failure in diabetic men was largely ignored. Recently more men and their wives have been seeing their doctors about this problem. It is important that men be fully educated about this problem and treatment options should be offered. Diabetes prevention and control should also form part of management of these individuals lives. Erectile failure is very common in diabetic men and this topic should no longer be a taboo subject.

Dr Brett Hodge is a Family Physician and Specialist Obstetrician / Gynaecologist with a Medical practice in the JOHNSON BUILDING in THE VALLEY.