Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Endocr Disord. 2022 Aug 17;22(1):206. doi: 10.1186/s12902-022-01108-1.
Male sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic.
A cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher's exact for dichotomous variables and independent sample t-test for continuous variables.
Two hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p < 0.001) and duration of diabetes (10.9 ± 7.6 vs 5.8 ± 4.6 years, p < 0.001) were higher while eGFR was lower (73.9 ± 27.7 vs 100.51 ± 28.08 years, p < 0.008) among those with ED compared to those without. Diabetic retinopathy (4% vs 42%, p < 0.001), peripheral neuropathy (17.9% vs 38.4%, p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography.
Male sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.
男性糖尿病患者的性功能障碍通常是一个未被揭示的临床问题。尽管许多出版物都报道了其患病率，但关于其相关性、影响和寻求治疗的情况的数据有限。本研究的目的是评估在选定的三级保健糖尿病诊所中，男性糖尿病患者的男性性功能障碍的患病率、其相关性、影响和治疗寻求情况。
这是一项 2020 年 1 月至 9 月在斯里兰卡国家医院糖尿病诊所进行的横断面研究。连续招募年龄在 18 至 70 岁、正在接受年度评估的糖尿病男性患者。使用访谈者管理的问卷收集社会人口统计学和临床信息。使用经过验证的自我管理问卷评估勃起功能障碍（ED）、早泄、心理健康和生活质量。进行心血管自主反射测试和总睾酮水平检测。对有勃起功能障碍的患者进行阴茎彩色多普勒超声检查。使用卡方检验或 Fisher 确切检验比较二分类变量，使用独立样本 t 检验比较连续变量。
共招募了 212 名参与者，平均年龄为 54.1（标准差=10.1）岁。168 名（45 名轻度、56 名轻度中度、26 名中度、41 名重度）患者存在 ED。26 名（18.7%）存在早泄。16%的患者性欲低下。尽管 60.5%的患者出现心理和/或关系问题，但 85.6%的患者未向医疗服务提供者透露性功能障碍。在 18 名寻求治疗的患者中，只有 4 名患者的治疗效果良好。ED 患者的平均年龄（55.4±9.5 岁 vs 48.7±10.6 岁，p<0.001）和糖尿病病程（10.9±7.6 年 vs 5.8±4.6 年，p<0.001）较高，而 eGFR 较低（73.9±27.7 岁 vs 100.51±28.08 岁，p<0.008）。与无 ED 患者相比，ED 患者中糖尿病视网膜病变（4% vs 42%，p<0.001）、周围神经病变（17.9% vs 38.4%，p=0.041）和下肢动脉疾病（0% vs 12.2%，p=0.04）的发生率较低。接受阴茎彩色多普勒超声检查的患者中，有 50%存在动脉功能不全。
尽管男性糖尿病患者的性功能障碍会对个人产生影响，但它仍是一个普遍存在但未被充分认识的糖尿病护理问题。患者和疾病特征将指导在临床实践中针对高危人群进行有针对性的筛查。
