Erectile dysfunction in diabetic men is linked more to microangiopathic complications and neuropathy than to macroangiopathic disturbances

Abstract

Background The aim of this study was to evaluate the importance of macro- and microangiopathic diabetic complications, especially diabetic neuropathy (DN), as risk factors for diabetic erectile dysfunction (DED). Methods In this cross-sectional study, the clinical records of 150 consecutive patients with a mean age (±standard deviation) of 53.0 (±12.5) years, mean diabetes duration of 8.6 (±6.7) years and diabetes type 1/2 = 39/111 were analyzed. Data on macroangiopathy (arterial hypertension, coronary artery disease (CAD), cerebral vascular disease (CeVD), dyslipidaemia) and microangiopathy (nephropathy, retinopathy, symptoms and predetermined diagnosis of diabetic neuropathy (DN)) was collected. Modified Neuropathy Disability Score (NDS), vibration (VP), thermal (TP) and 10 g monofilament (MF) perceptions and Achilles reflexes (AR) for somatic DN together with a new test for sudomotor autonomic DN (Neuropad) were used as diagnostic tools. DED was diagnosed using a questionnaire, based on the answer to the question about having erectile problems. Results DED was present in 44.7% of men with significant dependence on age and diabetes duration. The prevalence of arterial hypertension ( p < 0.05) and CAD/CeVD ( p < 0.05) was higher in the DED group, but the differences in nephropathy ( p < 0.01), retinopathy ( p < 0.001) and neuropathy ( p < 0.001) were more significant. After adjustment for age, the duration of diabetes (odds ratio (95% confidence interval (CI); p value): 1.054 (1.010–1.099; p < 0.05)), retinopathy (5.512 (2.469–12.305; p < 0.001)), symptoms of DN (2.428 (1.138–5.179; p < 0.05)) and diagnosis of DN (2.805 (1.406–5.597; p < 0.01)) remained as risk factors for DED. All neuropathic tests were significantly more unfavourable in the DED group. After adjustment for age and diabetes duration, best predictors for DED were NDS and VP. Only 4.5% of men had been treated for DED. Conclusions Erectile dysfunction in diabetic patients is a specific entity. Microvascular diabetic complications are more important risk factors for ED than macrovascular ones. Our data support the hypothesis that in the complex pathogenesis of DED, DN is a more important pathogenic factor than macroangiopathy.