Management of erectile dysfunction in diabetes: an update for 2008.

Tumescence occurs as a result of nitric oxide (NO)-mediated smooth muscle relaxation of the erectile tissue leading to engorgement of the corpus cavernosum. The process is initiated by neuronal NO release and maintained by NO released by the local vascular endothelium. Erectile dysfunction (ED) affects 30% to 40% of diabetic men and occurs as a result of endothelial dysfunction and autonomic neuropathy. The close association with endothelial dysfunction means ED is an early marker of cardiovascular risk. Managing ED is easy and must be part of a diabetes care service. Phosphodiesterase type 5 inhibitors are the treatment of choice, but are effective in only 50% to 60% of diabetic men. The reasons for nonresponsiveness remain uncertain and research is needed in this area. There has been much recent interest in the potential relationship between late-onset hypogonadism and diabetes, but there is no evidence of a causal relationship and the evidence in favor of treating borderline hypogonadism in diabetes is limited.