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Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body.
Fig 1. Autonomic Neuropathy anatomical area covered
Fig.2. Retrograde ejaculation, a common symptom of male sexual dysfunction in Diabetes Mellitus.
Both men and women with diabetes can develop sexual problems because of damage to nerves and small blood vessels. When a person wants to lift an arm or take a step, the brain sends nerve signals to the appropriate muscles. Nerve signals also control internal organs like the heart and bladder, but people do not have the same kind of conscious control over them as they do over their arms and legs. The nerves that control internal organs are called autonomic nerves, which signal the body to digest food and circulate blood without a person having to think about it. The body's response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax. Damage to these autonomic nerves can hinder normal function. Reduced blood flow, resulting from damage to blood vessels can also contribute to sexual dysfunction.
Diabetic neuropathy and related sexual and urologic problems appear to be more common in people who
poor blood glucose control
high levels of blood cholesterol
high blood pressure
older than 40
Autonomic neuropathy can gradually decrease sexual response in men and women, although the sex drive may be unchanged. A man may be unable to have erections or may reach sexual climax without ejaculating normally.
Fig.1. Diagrammatic representation of Type 2 Diabetes Mellitus.
The nerve damage of diabetes may cause sexual or urologic problems.
Sexual problems in men with diabetes include
Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection.
Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger.
Retrograde ejaculation is a condition in which part or all of a man's semen goes into the bladder instead of out the tip of the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. With retrograde ejaculation, semen enters the bladder, mixes with urine, and leaves the body during urination without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. Analysis of a urine sample after ejaculation will reveal the presence of semen. Poor blood glucose control and the resulting nerve damage can cause retrograde ejaculation.
- Check your blood sugar level as advised by your doctor. Your doctor will help you set your blood sugar goals. Most people with type 2 diabetes only need to check their blood sugar once or twice a day.
- Maintain a well-balanced healthy diet.
- Keep your body weight under control.
- Exercise regularly after consultation with your doctor.
- Take medicines regularly as prescribed.
- Pay special attention at your foot.
if you have Type 2 Diabetes Mellitus
- Do not neglect if you have any of the symptoms of diabetes mellitus or there are some family history of diabetes.
- Avoid taking junk foods, foods rich in carbohydrates and drinks containing sugar.
- Do not stop taking medicines unless your doctor advises so.
- Do not neglect if you notice any infection or numbness of your feet.
To prevent problems from diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.
People with diabetes can lower their risk of sexual problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their health care provider recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease.
Men who experience erectile dysfunction should consider talking with a health care provider. The health care provider may ask about the patient's medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes of sexual problems. The health care provider will check blood glucose control and hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life.
Tests for underlying problems may include:
Physical exam. This may include careful examination of your penis and testicles and checking your nerves for feeling.
Blood tests. A sample of your blood may be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health problems.
Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
Ultrasound. This test can check blood flow to your penis. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to determine if blood flow increases normally.