Clinical studies on impaired male sexual function in diabetes mellitus

Abstract

1) Purpose of investigationIt is well-known that impotence is frequently seen in male diabetics. However, only a few reports, for example by Rubin and Babbott, and Schoffling, have concerned with its frequency and the literature on its etiology reveals considerable disagreement. Miller and Mason, Horstmann Bergqvist and Schoffling considered endocrinologic factors to be of importance, while other investigators regarded them as a symptom of diabetic meuropathy. The purpose of this investigation is to study on the frequency and eteology of impotence in male diabetics and its treatment.2) Methods of investigationa) Postal inquies were made in 34 male diabetics and 260 male nondiabetic physicians belonging to the association of medical doctors of the prefecture and their sexual function was compared.b) Mainly endocrinologic and neurologic investigations were carried out in 29 cases of male diabetics ranging from 45 to 79 years of age who were treated at the Department of Urology. Kumamoto University Hospital. The results were compared between the patients with and those without impotence.3) Resultsa) Impotence was found in 8 out of 34 diabetics (26.7%), while it was in 18 out of 260 nondiabetic physicians (6.9%). The onset of impotence was about 10 years earlier in diabetics than in non-diabetic physicians.b) In general, diabetics with impotence were more aged and have suffered from a longer course of diabetes than those uncomplicated by impotence.c) The main cause of impotence in diabetes was an inability to erect. In most cases sexual desire lasted for some time while erection was not possible.d) Patients with impotence generally showed impaired glucose tolerance, while fasting blood glucose levels were not always high.e) There was no significant difference in 17-KS levels between diabetics and non-diabetics, and between diabetics with impotence and those without impotence. Fraction IV and V showed a tendency to decrease in diabetics with impotence.f) Histologic examination of the testicle in diabetics revealed hypospermatogenesis and thickning of the basal membrane of tubuli seminiferi, irrespective of the complication of impotence.g) The association of diabetic neuropathies was seen in 16 out of 17 diabetics with impotence (94.4%), and in 1 out of 7 diabetics without impotence (14.3%). Micturitional difficulties were seen in 7 out of 22 diabetics with impotence (31.8%), but not in the case without impotence.h) All of 21 diabetics with impotence showed abnormal cystometrogams, for example increased capacity and pressure (type I) in 6 cases (28.6%), lightly hypotonic type (type II) in 9 (42.9%), typical hypotonic type (type III) in 2 (9.5%), and hypertonic type (type IV) in 4 (19.0%). One diabetic without impotence out of (14.3%) showed type VI cystometrogram.i) Erection was restored in 6 of 12 treated cases. Those with type IV cytstometrograms responded best to treatment. The therapeutic effectiveness appeared in accordance with the changes in the cystometrogram. The most effective agent was vitamin B1 preparation in high dosage, erection being restored in 5 out of 7 cases who had received this treatment. It may be stated that the shorter the duration of inability to erect, the more favorable is the response to treatment. The effectiveness was not influenced by the duration of diabetes.4) CommentIt is concluded, based on the above-stated results, that the main cause of impotence in male diabetics is one of the diabetic neuropathies resulted from the disturbance of autonomic and somatic nerves responsible for a reflex are between the center of erection and the penis. The endocrinologic disturbances due to abnormal metabolism may be a secondary factor.