Sexual dysfunction in men with type 2 diabetes.

Sexual dysfunction (SD) is common in type 2 diabetic men, but few subjects are diagnosed and treated. The prevalence of diabetes mellitus is increasing worldwide. It is expected that the number of subjects suffering from SD increases in the near future. Most studies of SD in diabetic men have focused on erectile dysfunction. There is a dearth of studies in the area of the other forms of SD. SD has consequences on the psychological well-being and reproductive function. They can be the first symptom of comorbidities or a treatment side effect. Erectile dysfunction is increasingly being recognised as an early marker of organic incipient systemic disease. Evaluation for any SD includes a complete medical history, detailed sexual history, physical examination, psychosocial assessment and, sometimes, complementary studies. Initial treatment of any SD should eliminate any modifiable factor that may lead to or aggravate the dysfunction. Phosphodiesterase type 5 inhibitors are the preferred therapy for most men with organic erectile dysfunction who do not have a specific contraindication to their use. Pharmacological treatment of premature ejaculation includes on-demand or daily dosing of certain selective serotonin reuptake inhibitors or clomipramine and on-demand topical local anaesthetics. Delayed ejaculation and anejaculation due to vascular or neuropathic damage are usually irreversible. The issue of infertility in patients with anejaculation or retrograde ejaculation seeking to have children should be addressed. No study specifically conducted in diabetic men on the treatment of hypoactive sexual desire disorder, apart from that occurring in the context of hypogonadism, has been published.