Treatment Options

Impotence and Diabetes

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
Further Information

 

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Treatment Options

Psycho-sexual therapy
This may be recommended where psychological factors are considered to be an important part of the causes of erectile dysfunction. It may be recommended in combination with other treatments.

Cochrane Review of psychosocial interventions for erectile dysfunction
A meta-analysis was carried out looking at all the research for erectile dysfunction to compare the effectiveness of psychological treatment [therapy] and treatment with oral drugs, vacuum devices or other psychological interventions. The reviewers searched for randomised controlled trials carried out between 1966 and 2007 and found 11 trials involving 398 men. Their conclusions were:

  • Group psychotherapy therapy improves erectile dysfunction in selected patients.
  • Focused sex group therapy was more effective than no treatment.
  • Men who received group therapy and Viagra [sildenafil] showed significant improvement of erectile dysfunction and were less likely than those receiving only Viagra to drop out.
  • No difference was found when comparing the effectiveness of psychological interventions with local injection and vacuum devices.

Ref: Melnik T, Soares BGO, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004825. DOI: 10.1002/14651858.CD004825.pub2

Hormone treatments
Only a small number of cases of erectile dysfunction are caused by hormonal imbalance – most often reduced levels of testosterone. If this is the case, testosterone replacement can then be used.

Oral medications
There are now three drugs in tablet form on the market used to treat erectile dysfunction

  • Viagra [Sildenafil, Pfzer]
  • Cialis [Tadafil, Lilly]
  • Vardenfil or Levitra [Bayer/GlaxoSmithKline]

They all act in the same way by helping the smooth muscles in the penis to relax so increasing the blood flow to the penis causing an erection. They will only work if the man is sexually stimulated. None of them should be taken in combination with each other.

Viagra – This was the first drug of its type on the market. It should be taken about an hour before sexual activity and on average takes 20 to 60 minutes to work and within a 4 to 6 hour period after taking the tablet, an erection should occur.

Side effects are usually mild and transient with the most common being headache and flushing. It should not be taken with other medicines unless the doctor says it is safe to do so.

Not to be taken by people who are taking medicines that contain nitrates, these are commonly prescribed for angina sufferers. Also people with the following conditions:

  • Severe heart or liver problems
  • Recent heart attack, stroke or low blood pressure
  • Certain rare eye diseases eg retinitis pigmentosa.

Cialis – This is a new drug and within 30 minutes of taking it, 50% of men can get an erection if sexually stimulated and its effects last for 24 hours. So the manufacturers say that it will allow men with erectile dysfunction to choose when they want to have sex and will allow couples greater spontaneity. The publicity material says that in clinical trials Cialis worked in four out of five men.

Side effects are usually mild and transient, the most common being headache and indigestion. Less common side effects include stuffy nose, flushing, myalgia, dizziness and backache.

It should not to be taken by people who are taking medicines that contain nitrates. It should also not be taken by men with the following:

  • Severe cardiac disease where sexual activity is inadvisable
  • Heart attack in the last 90 days or significant heart failure in the last 6 months
  • Stroke within the last 6 months
  • Unstable angina
  • Uncontrolled arrhythmias [irregular heart beat], low or untreated high blood pressure

Vardenafil or Levitra – The latest drug where clinical trials have shown that is effective and reliable in a wide range of men with erectile dysfunction. It normally works within 25-60 minutes and within a 5 hour period after taking.

Side effects are usually mild and transient with the most common being headache and flushing.

Not to be taken by people who are taking medicines that contain nitrates. It should also not be taken by men with the following:

  • Severe cardiac disease where sexual activity is inadvisable
  • Recent stroke, heart attack or low blood pressure
  • Unstable angina

Research among men with diabetes 73% taking 20mg Vardenfil/Levitra showed a significant improvement in erections. Most adverse events were mild to moderate and transient – headache, flushing, rhinitis dyspepsia, nausea and dizziness.