ERECTILE dysfunction, the inability to have and maintain an erection effective for penetration and successful sex, is very common among men with diabetes. The lack of libido is also seen among diabetic women. The damage to the blood vessel and nerves caused by diabetes, especially those with poorly controlled blood sugar level, is the reason for lack or loss of libido among these individuals.
The drug factor
Other causes of erectile dysfunction include medications for the treatment of blood pressure and heart disease, anxiety and stress, and some other psychological conditions, like depression. These medications are known to lower libido and erection. Even financial dilemma could cause sexual dysfunction among men and women.
Having low libido and the inability to consummate sexual intimacy could be very frustrating and devastating to people. It could ruin relationships, marriages, and lives.
However, there are remedies and strategies available today that could help. The very first one is living a healthy lifestyle. This includes a healthy diet of fish, chicken, less or no red meat, a lot of vegetables, legumes, some fruits and nuts. Abstaining from tobacco (it constricts blood penile blood vessels too, besides coronary arteries of the heart) and/or illicit drugs (including marijuana), avoidance of alcohol, daily exercise (even walking, briskly or paced according to tolerance), and stress management, are a great help. These are within your personal control, and discipline and resolve are certainly vital here. A positive attitude and outlook in life could make a tremendous difference in the solution of this sexual dilemma.
The next is to consult your physician, who will interview you in great detail about your personal life, behavior, habits, compliance with medications for diabetes, heart disease, etc., conduct a thorough physical examination and do some blood tests. This comprehensive work-up will provide your physician important diagnostic impressions which will guide him as to what to prescribe for you. Talking to your medical counselor is a must.
For inner peace
In the management of this condition, the primary physician might recommend consultation with a psychiatrist, who millions of normal businessmen and other professionals seek to reduce anxiety and stress and prevent nervous breakdown, burnout, depression, and physical illnesses. Seeing a psychiatrist today, unlike a century ago, is no longer restricted to people who are “crazy.” Today, it is part of a healthy lifestyle and disease prevention, whenever needed as part of stress management, for inner peace.
More complicated for women
Among women, the lack or absence of libido (sexual desire) is more complicated than low hormonal level (in men, it is low T, or testosterone). A consultation with an OB-gyne expert is strongly recommended. The use of vaginal lubricant has been most helpful in some women. Since men have to do the penetration, the treatment of erectile dysfunction might also help some women in achieving sexual gratification. Women with more complicated issues could benefit from further medical consultation.
As far as erectile dysfunction is concerned, the following strategies are available today:
The ED magic pills: Sildenafil (Viagra), Verdenafil (Levitra, Staxybn), Tadalafil (Cialis, Adcirca), Avanafil (Stendra) dilate (open up) blood vessels and allow them to fill up with blood to cause engorgement, rigidity, firmness, and erectness, effective for penetration and sustained and successful act and ejaculation. Persons taking nitroglycerin and other heart artery vasodilators must NOT take any of these ED pills, as the combination could lead to severe fall in blood pressure and death. Talk to your physician before taking any new medications he did not prescribe, including herbals or supplements.
There is also a type of suppository which could be inserted into the tip of the penis before sexual activity, or a solution to inject at the base of the penis to induce erection which could be used, under your physician’s guidance. Then, there is the vacuum suction device, a penis pump that draws blood into your penis to cause erection. Also marketed is a band to be placed around the base of the penis to prevent blood from leaving the penis, causing it to engorge.
If the pills, the pump, all other measures fail, physicians might recommend penile implant, a surgical procedure to insert a semi-rigid or inflatable penile implant, controlled by a “button” to inflate to cause rigidity for sex, or deflate after sex.
For either men or women, obesity (or being overweight) lowers libido besides sexual performance. Dieting and physical exercises, on the other hand, improves sexual desire and prowess in bed.
Talking about diabetes mellitus type 2, the most popular first line of drug is metformin. It does not lower blood sugar level like insulin does. Metformin works by fighting (reducing) our body cell-resistance to our own insulin produced by our own pancreas and also control the sugar released by the liver to the blood stream. When our cells are resistant to insulin (not allowing insulin to go into the cell), we develop slow metabolism and retain sugar and fats in our body, leading to overweight and high cholesterol level. Metformin increases the sensitivity of the cells to insulin, enabling insulin to enter our cells and do its job for sugar metabolism and energy formation.
While we normally produce insulin (endogenous) within us for sugar metabolism, it needs to be able to go into our body cells in order to function and aid in glucose metabolism and produce energy for our bodily needs. When the cells are resistant to insulin (unable to enter our cells), then our blood sugar is not metabolized and not used, so our glucose level goes up. This is what pre-diabetes or diabetes type 2 is. The other type of diabetes is when the pancreas is unable to produce endogenous insulin and the person is dependent on exogenous (prescribed) insulin injections for life. Metformin alone cannot solve this problem of absence of insulin production.
Metformin was discovered in 1922. Human research on metformin use started in the 1950s by Jean Sterne, a French physician. It was marketed as a medication in France in 1957 and in the United States in 1995. Metformin has been found to be safe with relatively mild side effects in some people and none or temporary in majority of users. Metformin also helps prevent type 2 diabetes for those at high risk (heredity) of developing it. Metformin is usually prescribed when dieting and exercise alone are unable to control blood sugar level.
Unlike some other medications for glucose control, metformin does not cause weight gain.
Long term use of metformin has not been shown to cause kidney damage. Those with poor kidney function might lead to a build-up of metformin in the body, unable to excrete the drug efficiently, causing lactic acidosis. Physicians monitor this situation so it is prudent for patients to make regular medical visits Studies have suggested that those on metformin have lower risk for cancer. There are even suggestions in recent studies that metformin improves longevity. Larger independent studies are needed to confirm this marvelous potential.
Philip S. Chua, MD, FACS, FPCS, cardiac surgeon emeritus based in Northwest Indiana and Las Vegas, is an international medical lecturer, author, and Chairman of the Filipino United Network – USA, a 501(c)3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888.com Email: [email protected]