Optimal treatment of erectile failure in patients with diabetes.

Erectile failure, although a common problem in male diabetic patients, is one of the most neglected complications of diabetes. The availability of drugs like alprostadil (prostaglandin E1; PGE1) and papaverine for intracavernosal injection and the development of vacuum tumescence devices, while making therapy simple, have also reduced the necessity for specialised investigations. In the past 10 years, alprostadil has been shown to be the safest and the most effective of the intracavernosal self-injection treatments of erectile dysfunction. Vacuum tumescence devices are an acceptable noninvasive alternative in those who fail to achieve a satisfactory response to self-injection. Surgical techniques are being improved every day, and revascularisation procedures and prosthetic implants are available to couples in specialised centres. At present, systemic drug therapy has been largely ineffective for treatment in diabetic patients but progress is being made in this field. Whatever the option, involvement of the partner in decision making is of major importance for the treatment to be successful, and psychosexual counselling is a useful adjunct to medical or surgical therapy.