Diabetes and sexual dysfunction: current perspectives

Figures & data

Table 1 Summary of the behavioral and pharmacological therapies of erectile dysfunction in diabetes

Therapy	Mechanism of action	Indication
Lifestyle changes (weight reduction, smoking cessation, physical exercise)	Risk factor modification	Obesity and associated cardiovascular risk factors
PDE5 inhibitors	They inhibit the PDE5 enzyme, prolonging the activity of cGMP in the cavernous smooth muscle, resulting in increased vasorelaxation and rigid penile erection	First-line pharmacological therapy (contraindicated in nitrate users)
Intracavernosal or transurethral vasoactive substances:		Second-line pharmacological therapy, unresponsive to PDE5 inhibitors
– PGE1	It increases the concentration of cAMP, causing smooth muscle relaxation
– Phentolamine	Alpha adrenoreceptor blocker
– Papaverine	Nonspecific PDE inhibitor
Testosterone	It replaces normal testosterone levels	Diabetes-associated hypogonadism

Abbreviations: PDE5, phosphodiesterase-5; cGMP, cyclic guanosine monophosphate; PGE1, prostaglandin E1; cAMP, cyclic adenosine monophosphate; PDE, phosphodiesterase.

Table 2 Summary of the available therapies for female sexual dysfunction

Modification of risk factors (weight control, healthy diet, regular exercise)

Addressing psychological issues

Cognitive behavioral psychotherapy for desire disorders or vaginismus

Clitoral therapy device for arousal or orgasm disorders

Treatment of depression, if present

Hormonal replacement therapy in postmenopausal women