Bằng chứng của tổn thương mô bệnh tiểu đường ở những nơi khác như bệnh võng mạc, bệnh thận, bệnh thần kinh, và bệnh mạch máu ngoại biên, làm cho nó nhiều khả năng ED sẽ được liên quan đến tổn thương mô bệnh tiểu đường. | 166 I THE FAMILY AND THE DIABETIC MAN OR WOMAN problems. ED due to psychological factors may start suddenly be associated with reduced libido and be patchy . present with one woman and not with another or present during masturbation but not when intercourse is attempted. Drug-related ED is common and remediable drugs implicated include methyl dopa reserpine beta blockers phenothiazines cimetidine. Endocrine causes can be suspected by finding other evidence of hypogonadism clinically. Measure testosterone LH FSH and prolactin. Evidence of diabetic tissue damage elsewhere such as retinopathy nephropathy neuropathy and peripheral vascular disease make it more likely that the ED will be related to diabetic tissue damage. It is always worth improving blood glucose control as hyperglycaemia can cause non-specific malaise which may be associated with ED there are obviously many other reasons for improving blood glucose balance . An erectile response to alprostadil injection demonstrates adequate vascular supply. In unresponsive patients angiography may identify treatable vascular disease. If autonomic neuropathy is evident elsewhere . with postural hypotension or problems with bladder emptying the ED is likely to be neurogenic. More detailed studies can be undertaken in specialist centres. Treatment of erectile dysfunction Do a full clinical assessment and relevant blood tests in everyone. Provide psychological support as needed. Some patients will need specialist psychosexual counselling. Sildenafil Viagra is licensed for use in diabetic men with ED and may be effective in over 50 per cent of cases depending on the severity of any vascular or neurological tissue damage. Do not prescribe sildenafil for men in whom sexual activity could be harmful . patients with unstable angina . Avoid sildenafil in patients with renal failure creatinine clearance below 30 ml min hepatic failure blood pressure below 90 50 recent history of stroke or myocardial infarction known .
