It's Important to Take Sexual History in Diabetics

By Finn, Robert | Clinical Psychiatry News, May 2004 | Go to article overview

It's Important to Take Sexual History in Diabetics


Finn, Robert, Clinical Psychiatry News


SAN FRANCISCO -- Phosphodiesterase type 5 inhibitors remain the treatment of choice for sexual dysfunction in diabetic men, but it's important for primary care physicians to take a thorough sexual history and to refer patients to urologists when indicated, Dr. Thomas C. Keyserling said at a meeting sponsored by the American Diabetes Association.

Although men with sexual dysfunction have a number of treatment choices, for women both the literature and the treatment options remain rudimentary, said Dr. Keyserling, of the University of North Carolina at Chapel Hill.

Studies show that a large percentage of diabetic patients suffer from sexual dysfunction at least occasionally. In one survey of male diabetics, 34% said they had frequent erectile dysfunction and another 24% said they had occasional erectile dysfunction.

A separate study of women with type 1 diabetes found that 27% reported sexual dysfunction, compared with 15% of women in an age-matched control group. Diabetic women in this relatively small study (120 women) reported that they had significantly more problems with lubrication, but otherwise there were few differences between diabetic and control women.

Treatment of sexual dysfunction in diabetic men should begin with a thorough sexual history. "It's amazing how much you hear if you give men an opportunity to talk about sexual dysfunction," Dr. Keyserling said.

"I think it's important to characterize the erectile dysfunction, that is, when it started, how often there's less-than-satisfactory function, and so forth," he said.

Then conduct a physical exam, focusing on femoral and pedal pulses, genital and perineal sensation, and secondary sexual characteristics such as male development and testicular size.

Peripheral vascular disease can be diagnosed on the basis of decreased femoral and pedal pulses, and neuropathy can be diagnosed on the basis of decreased sensation. Both can result in erectile dysfunction.

Have the lab measure the patient's testosterone level. If it's low, go on to have the lab measure free testosterone, prolactin, and luteinizing hormone.

Prescribe testosterone replacement therapy only when there's evidence of hypogonadism. …

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