1 / 25

Sexual dysfunction & Diabetes

Sexual dysfunction & Diabetes. S. Vahidi M.D. Male sexual dysfunction. Inability to achieve a satisfactory sexual relationship Inadequacy of erection Problem with emission, ejaculation or orgasm. Physiology of Erection. Innervation of the penis Autonomic

janepetersen
Télécharger la présentation

Sexual dysfunction & Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sexual dysfunction &Diabetes S. Vahidi M.D.

  2. Male sexual dysfunction • Inability to achieve a satisfactory sexual relationship • Inadequacy of erection • Problem with emission, ejaculation or orgasm

  3. Physiology of Erection Innervation of the penis • Autonomic T12- l2 (sympathetic ) & S2 S4(parasympathetic)  Inferior hypogastric & pelvic plexus  Pelvic organ: Cavernous nerve • Somatic Sensory: pain- temperature- touch- vibratory  Thalamus Motor: S2-S4+ pudendal nerve  Bulbo cavernous M. Ischiocavernous M. • Supraspinal Forebrain Brain stem Hypaothalamus Midbrain The brain has a modulatory effect on the spinal pathway of erection.

  4. Erection types • Genital stimulated (contact or reflexogenic) • Central-stimulated (non contact or psychogenic) • Central originated (nocturnal) (in REM period)

  5. Physiology of erection Hemodynamic • Artery: internal pudendal • Bulbo urethral • Dorsal a. • Covernous a. (deep a.) • Vein: • Deep dorsal vein (glans- corporacovernosa) • Circumflex- urethral- bulbar vein (corpus spongiosum) • Cavernous- crural vein- deep dorsal vein (corpora cavernousa)

  6. Phases of erection process • Flaccid Ph. • Latent (filling) Ph. • Tumescent Ph. • Full erection Ph. • Rigid erection Ph. • Detumescent Ph.

  7. Mechanism of penile erection

  8. Hormons and sexual function • Androgens are essential for male sexual maturity • Androgens enhances but are not essential for erection

  9. Neuro transmitters and erection • Adrenergic flaccid • Cholinergic (No) erection • Non adrenergic non cholinergic (No) erection • Prostaglandins- endothelins and angiotensin

  10. Male sexual dysfunction • Inability to achieve a satisfactory sexual relationship • Inadequacy of erection • Problem with emission, ejaculation or orgasm

  11. Epidemiology of E.D. • 52% of male between 40 and 70 years have E.D. • 17% mild E.D. • 25% moderate E.D. • 10% complete E.D. • The major predictor of E.D • Diabetes mellitus • Heart disease • Hypertension • ↓HDL

  12. Diabetes mellitus, although the most common endocrinologic disorder cause E.D. through its vascular, neurologic, endothelial and psychogic complications rather than hormon deficiency per se. Failure to initiate = neurogenic Failure to file= arterial Failure to store= venous Classification of E.D.

  13. Diabetes & E.D. • About 50% of men with chronic D.M. have E.D. • E.D has been estimated to occur in 35% to 75% of men with D.M. • Deterioration of sexual function was the first symptom in 12% of D.M. • The prevalence of E.D is three times higher in diabetic men (28% versus 9.6%) • E.Doccurs at an earlier age and increases with disease duration in D.M. • The incidence of E.D in D.M. is age dependent • 15% at age 30 • 55% at age 34-60

  14. Diabetes & E.D. • Diabetes may cause E.D. through its effect on CNS peripheral nerve function, androgen production, psychological factors vascular integrity, and endothelial and smooth muscle function. • There is no correlation between insulin dosage, duration of disease, the effectives of disease control and E.D.

  15. Identify the cause of E.D • Intra cavernosal inj • Duplex scanning • Cavernosometry and cavernosography • Arteriography • NPT • Rigiscan

  16. Treatment of E.D • Lifestyle changes • Changing medications • Psychosexual therapy • Hormonal therapy • Phosphodiesterase inhibitors (sildenafil) • Yohimbin – trazodone- apomorphine • Trans urethral therapy • Intra cavernous injection Papaverin- phentolamin- prostaglandin E1 • Vacuum device • Vascular surgery • Penile prosthesis

  17. Disorders affecting emission, ejaculation & orgasm • Premature ejaculation • Retrograde ejaculation • Dry ejaculation

  18. Female sexual dysfunction & diabetes • Diabetes metabolic problem  loss of desire • Diabetes  psychologic problem  loss of desire • Strong correlation between depression & F.S.D. in diabetic with neuropathy. • F.S.D. in diabetic: orgasm- arousal- painful orgasm- desire- lubricant problem

More Related