reference from cpg DM 2015 malaysia

1. COMPLICATION OF
DIABETES
Sexual Dysfunction
Male sexual dysfunction
Female Sexual Dysfunction

2. MALE SEXUAL DYSFUNCTION
in diabetic patients  include
disorders of libido, ejaculatory
problems, and erectile dysfunction
(ED)

3. DEFINITION
 inability to achieve, maintain
or sustain an erection firm
enough for sexual intercourse
that may result from
psychological, neurological,
hormonal, arterial, or
cavernosal impairment or
from a combination of these
factors,

4. PREVALENCE
 varies from 35% to 90%
 3x more common in diabetic men
 age
 duration of diabetes and poor glycaemic control,
presence of other diabetic complications
 hypertension,
 hyperlipidaemia,
 sedentary lifestyle and smoking

5. PHYSIOLOGY OF ERECTION
sexual stimulation
neural impulses from brain are conveyed
along the spinal cord, exiting  pelvic
parasympathetic preganglionic nerves 
cavernosal nerves
their nerve endings release a 
nitric oxide
Nitric oxide activates the enzyme guanylyl
cyclase, which lyses GTP  cGMP

6. relaxation of vascular smooth muscle in
the arteries, arterioles, and sinusoids of the
corpora cavernosa
the distended sinusoids compress venules
against the fibroelastic covering of the
cavernosal bodies and trap the blood in
cavernosal bodies.
trap the blood within the corpora cavernosa
and raise the penis from to erect
Veno-occlusive Mechanism

7. SCREENING AND DIAGNOSIS
 screened for any symptoms or signs of
hypogonadism and early morning serum
testosterone should be performed
 Screening  5-item version of the International
Index of Erectile Function (IIEF) questionnaire

9. TREATMENT
 Optimisation of glycaemic control, management of
other comorbidities and lifestyle modifications
 Psychosexual counseling
 treatment = Phosphodiesterase-5 (PDE-5) inhibitors
(sildenafil, tadalafil and vardenafil)
 confirmed hypogonadism = treated with IM
testosterone
 Other therapies  intracavernosal injections,
intraurethral alprostadil, vacuum devices

11. FEMALE SEXUAL DYSFUNCTION
 Female sexual function appears to be more
related to social and psychological
consequence of diabetes than to the
physiological consequence.

12. DEFINITION
 defined as persistent or recurring decrease in
sexual arousal, dyspareunia and a difficulty
or inability to achieve an orgasm that leads
to personal distress and relationship
difficulties
 consist of female sexual interest/arousal
disorder, orgasmic disorder and genito-
pelvic pain/penetration disorder

13. PREVALENCE
 24–75% in diabetic women
 Age
 duration of diabetes, poor glycaemic
control, diabetic complications
 Menopause
 psychological factors (depression and
anxiety disorder)

14.  Depression
 imbalance in the hormonal levels of diabetic women
 Hyperglycemia reduces the hydration of the vaginal mucus
membranes poor vaginal lubrication and dyspareunia and
increases the risk of genitourinary infections
 atherosclerotic damage and diabetes-induced endothelial
dysfunction  reducing the engorgement of the clitoris
 Diabetic neuropathy may  altering both the normal
transduction of sexual stimuli and the triggered sexual
response.

15. INITIAL SCREENING CHECKLIST

16. DIAGNOSIS
 FSFI questionnaire that consists of 19 questions
 Physical examination  genital examination,
thyroid status or galactorrhoea
 Investigations: thyroid, prolactin and
gonadotrophins, to rule out metabolic or pituitary
dysfunction may be required

18. TREATMENT
 treat psychosocial disorders and relationship
disharmony
 Optimisation of glycaemic control

19. REFERENCES