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Complication of diabetes cpg DM 2015

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Complication of diabetes cpg DM 2015

  1. 1. COMPLICATION OF DIABETES Sexual Dysfunction Male sexual dysfunction Female Sexual Dysfunction
  2. 2. MALE SEXUAL DYSFUNCTION in diabetic patients  include disorders of libido, ejaculatory problems, and erectile dysfunction (ED)
  3. 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. 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. 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. 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. 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
  8. 8. 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
  9. 9. FEMALE SEXUAL DYSFUNCTION  Female sexual function appears to be more related to social and psychological consequence of diabetes than to the physiological consequence.
  10. 10. 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
  11. 11. PREVALENCE  24–75% in diabetic women  Age  duration of diabetes, poor glycaemic control, diabetic complications  Menopause  psychological factors (depression and anxiety disorder)
  12. 12.  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.
  14. 14. 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
  15. 15. TREATMENT  treat psychosocial disorders and relationship disharmony  Optimisation of glycaemic control
  16. 16. REFERENCES