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Male sexual issues encompass desire, erection, ejaculation, and orgasm problems, any of which may interfere with sexual activity and its enjoyment.
Healthy sexual functioning is based upon a “perfect storm” of well-functioning bodily systems, including intact genital blood flow and nerve function, healthy smooth muscle and sinus tissue within the erectile chambers, and well-functioning pelvic floor muscles.
Diabetes is the most common medical condition associated with sexual dysfunction with 35-45% of diabetic males experiencing sexual problems. These issues occur because of blood vessel disease (vasculopathy) and nerve disease (neuropathy), negatively affected the two key systems responsible for the ability to obtain and maintain an erection. Diabetes increases the risk of erectile dysfunction (ED) threefold, which typically occurs earlier and is of greater severity than in the non-diabetic population. In addition to ED, because of the neuropathy, many diabetic men experience retrograde ejaculation (“injaculation”), in which semen goes backwards into the bladder. Libido is often negatively impacted as well.
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Within the spectrum ranging from normal glucose metabolism to diabetes exists pre-diabetes, a common condition characterized by a mild increase in blood glucose and or hemoglobin A1c. Many pre-diabetic men have visceral obesity, if not an abundance of intra-abdominal fat (as opposed to subcutaneous fat). Many physicians – myself included – believe that any male with visceral obesity is pre-diabetic regardless of serum glucose of hemoglobin A1c. Risk factors for prediabetes include overweight status, age more than 45 years, family history of diabetes, and sedentary lifestyle.
Visceral fat (a.k.a. “beer belly”) contains an abundance of the enzyme aromatase that catalyzes the conversion of testosterone to estrogen. Because of obesity and the presence of this enzyme, testosterone levels diminish and estrogen levels increase, potentially impairing many aspects of male sexuality (libido, erections, etc.) and promoting gynecomastia (man boobs) and a vicious cycle of a further increase in body fat from the altered testosterone/estrogen ratio.
Might you have prediabetes? Take the prediabetic test designed by the CDC.
If appropriate healthy lifestyle changes are not made, pre-diabetes often turns into full-blown diabetes, with potentially devastating health consequences. Complications of diabetes occur because of chronic elevated blood glucose and damage to blood vessels and nerves. Diabetes accelerates atherosclerosis, in which fatty deposits occur within the walls of arteries, compromising blood flow and the delivery of oxygen and nutrients to tissues. Diabetic “small blood vessel” disease can lead to retinopathy (visual problems leading to blindness), nephropathy (kidney damage leading to dialysis), and neuropathy (nerve damage causing loss of sensation). Diabetic “large vessel disease” can cause coronary artery disease, stroke, and peripheral vascular disease.
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There is mounting evidence that sexual dysfunction occurs more frequently and is of greater severity in pre-diabetic men as compared to men with no evidence of metabolic issues. The severity of sexual dysfunction in pre-diabetics increases progressively as a function of impaired glucose metabolism. Pre-diabetes may negatively affect testosterone levels, libido, and erectile function. The good news is that pre-diabetes, its negative sexual consequences, and most importantly, a potential lifetime of chronic illness, are entirely reversible with the incorporation of a healthy lifestyle.
Since pre-diabetic status is associated with sexual dysfunction, the presence of sexual dysfunction in any male may be a sign of pre-diabetes, even before a deficit in glucose metabolism is discovered. Therefore, males with sexual dysfunction should consider checking their serum glucose and A1c, (in addition to testosterone and a lipid profile). I strongly believe that any male with sexual dysfunction merits a visit to the cardiologist, since sexual dysfunction can be the tip of the cardiovascular iceberg and it is entirely possible that vascular disease is present elsewhere in the body (coronary arteries, carotid arteries, aorta, etc.) aside from the penis.
