Sexuality

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Sexuality

• Sexuality is interwoven with every aspect of
  human existence, and in its broadest
  sense,sexuality is defined as a desire for
  contact, warmth, tenderness or love. Humans
  express and live their sexuality in their
  daily lives, sexuality is not limited to an act
  of seduction or of intercourse but encompasses
  every area of our lives the way we relate to
  others,our friends,our family,and our work, it is
  evident in what we believe, how we behave and the
  way we look.
• Poorman, 1988

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Sexual self Sexual
concept function
Sexual role relationships
Woods,1987
3
Effects of diabetes on sexual function

• Erectile dysfunction 34-50
• Decreased loss of desire
• Premature ejaculation
• Retrograde ejaculation

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Effects continued

• Inadequate vaginal lubrication
• Reduced desire
• Increased time reaching orgasm

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Psychological effects

• Depression
• Fear of complications of diabetes/fear anxiety
  about the future
• Tiredness/fatigue
• ( possibly from hyperglycaemia)

• Low body self esteem respect
• Pain
• Disfigurement
• Pregnancy
• Alterations in relationship dynamics

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Prevalence of ED in menwith diabetes
ED prevalence ()
55
53
30
Alexander WD. Sexual function in diabetic men.
In Pickup J, Williams G, eds. Textbook of
Diabetes. 2nd ed. Oxford Blackwell Science, 1997
Hackett GI. Impotence the most neglected
complication of diabetes. Diabetes Res 1995 28
7583
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Recognising ED in menwith diabetes

• Diabetes is a common independent marker for ED
• ED can be an early symptom of diabetes
• ED can help to identify men with undiagnosed
  diabetes

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ED the missing link indiabetes care?
NSF for Diabetes Standard 2 Aim To ensure that
people with diabetes are identified as early as
possible The NHS will develop, implement and
monitor strategies to identify people who do not
know that they have diabetes
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Overlapping risk factorsfor ED and diabetes
The text in each circle shows aetiological
factors related to ED or diabetes. Conditions in
the overlapping area are relevant to both
diabetes and ED and are particularly relevant
to Type 2 diabetes Adapted fromCummings MH,
Alexander WD. Erectile dysfunction in patients
with diabetes. Hosp Med 1999 60 638644.
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Assessment of EDin men with diabetes
Fasting blood glucose (FBG) measurement in men
with unknown diabetes status
Evaluation of secondary sexual characteristics
Examination of penis and testes
Other investigations if indicated by the clinical
picture
Blood pressure measurement
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Effect on quality of life

• Both diabetes and ED have profound impact on
  quality of life
• Treatment for ED can improve self-esteem and
  motivation to manage diabetes

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Treatment of ED in menwith diabetes

• All currently licensed pharmacological treatments
  for ED are appropriate
• Neurovascular consequences of diabetes may mean
  patients are more resistant to treatment
• Psychosexual / couple therapy should always be
  considered

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Treatment of ED in menwith diabetes

• Pharmacological agents should not
• Adversely affect glucose or lipid homeostasis
• Interact with other medications, e.g.
  anti-diabetic drugs, anti-hypertensive agents
• Patient and partner choice is key when offering
  men with diabetes treatment for their ED
• Patients with Type 1 diabetes (41) are more
  likely to accept self-injection therapies for ED
  than patients with Type 2 diabetes (27)

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Pharmacological treatments for ED? PDE5
Inhibitors (sildenafil citrate)
General population
86
78
67
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(n 114)
(n 119)
(n 122)
(n 118)
according to Global Efficacy Questionnaire
(GEQ) Did treatment improve your erections?
Montorsi F, McDermott TE, Morgan R, et al.
Efficacy and safety of fixed-dose oral sildenafil
in the treatment of erectile dysfunction of
various etiologies. Urology 1999 53 10111018.
Prescribing information is available in NEED
Module 5.
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Treatment options

• Viagra
• Cialis
• Levitra
• Uprima
• Alprostadil Cavaject.MUSE.
• Vacuum device.
• Psychosexual therapy.
• Surgery

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Pharmacological treatments for ED? PDE5
Inhibitors (sildenafil citrate)
Diabetic population
Rendell et al
Blonde et al
63
56
17
10
(n 127)
(n 131)
(n 397)
(n 381)
Plt0.001 vs placebo
Plt0.001

• according to Global Efficacy Questionnaire
  (GEQ) Did treatment improve your erections?
• Rendell MS, Rajfer J, Wicker PA, Smith MD.
  Sildenafil for treatment of erectile dysfunction
  in men with diabetes. JAMA 1999 281 421426
• Blonde L, Korenman SG, Siegel RL, Orazem J.
  Sildenafil citrate for treatment of erectile
  dysfunction is similarly effective in men with
  type 1 and type 2 diabetes mellitus. American
  Diabetes Association 60th Scientific Sessions,
  San Antonio, Texas, 2000.

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Pharmacological treatments for ED? Dopamine
agonist (apomorphine hydrochloride SL)
General population
Diabetic population
(n 163)
(n 27)
46.9
32.3
39
29
Plt0.001
P0.017

• Dula E, Bukofzer S, Perdok R,
  George M, the Apomorphine SL Study Group.
  Double-blind, crossover comparison of 3 mg
  apomorphine SL with placebo and with 4 mg
  apomorphine SL in male erectile dysfunction. Eur
  Urol 2001 39 558564.

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Pharmacological treatments for ED?
Intracavernosal alprostadil
85.4
52.3
(n 322)
(n 21)
Desvaux P, Mimoun S. Prostaglandin E1 for the
treatment of impotence. Efficacy and tolerance as
a function of aetiology. J Urol 1994 100 1722.
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Pharmacological treatments for ED? Transurethral
alprostadil
65.9
27
Padma-Nathan et al
Fulgham et al
(n 1511)
(n 114)

• Fulgham PF, Cochran JS, Denman JL, et al.
  Disappointing initial results with transurethral
  alprostadil for erectile dysfunction in a urology
  practice setting. J Urol 1998 160 20412046.
• Padma-Nathan H, Hellstrom WJG, Kaiser FE, et al.
  Treatment of men with erectile dysfunction with
  transurethral alprostadil. N Engl J Med 1997
  336 17.

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PLISSIT
PERMISSION LIMITED INFORMATION SPECIFIC
SUGGESTIONS INTENSIVE THERAPY Annon,1970
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Useful references

• Egan, G (2004) The skilled helper. 7th Edition
  USA Brooks/Cole
• Gregory, P (2000) Patient assessment care
  planning Sexuality. Nursing Standard Vol 15 No
  9 pp 38 41
• RCN (2000) Sexuality Sexual Health in Nursing
  Practice.London RCN
• Schover,L (1997) Sexuality fertility after
  cancer.New York John Wiley

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References continued

• Enzlin,P, Mathieu,C et al ( 2003) Prevalence and
  predictors of sexual dysdfunction in patients
  with type 1 diabetes. Diabetes Care Vol 26 no 2
  409 414
• Enzlin,P Mathieu,C et al (2002) Sexual
  dysfunction in women with Type 1 diabetes A
  controlled study. Diabetes Care Vol 25 No 4 pp
  672-677
• Erol,B, Ozbey,I et al (2002) Sexual dysfunction
  in type II diabetic females a comparative
  study.Journal of Sexual and Marital Therapy Vol
  28 pp 55 62

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References continued

• Meeking,D et al (1997) Assessing the impact of
  diabetes on
• female sexuality. Community Nurse Vol 3 No 8 pp
  50 52
• Price,K ( 2004) Sexual dysfunction in women with
• diabetes. Practical Diabetes International Sep 21
  No 7 pp
• 244-246
• Sarkadi, A Rosenqvist, U ( 2003) Intimacy and
  women with
• type 2 diabetes an exploratory study using focus
  group
• interviews. Diabetes Educator Vol 29 No 4 pp 641
  - 652

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Useful contact numbers
British Association of Sexual Relationship
Therapists 0208 543 2707. www.basrt.org.uk Rel
ate Helpline (9.30 4.30 Mon- Friday) 0845 130
4010. Herbert Gray College, little Church street
Rugby.CV21 3AD 01788573241www.relate.org.uk