Erectile dysfunction may be first sign of other issues

In Singapore, one in eight men has diabetes.

Going by available data, 75 per cent of this pool of male diabetics will develop erectile dysfunction (ED).

Diabetes and ED are comorbidities, the simultaneous presence of one or more diseases or disorders in a patient.

Men with diabetes develop some level of ED unless they control their blood sugar strictly, said Dr Tan Kok Kuan from Dr Tan & Partners.

The statistics tell the story.

Male diabetics tend to develop ED 10 to 15 years earlier than men without diabetes.

Of male diabetics aged 50 and above, 60 per cent will have ED. The likelihood goes up with age - 95 per cent of male diabetics aged 70 will have ED, said Dr Tan.

Beyond the physiological impact of ED, patients may also suffer from loss of self-esteem and even depression.

Their relationship with their partners may also be affected.

But ED could also be the first sign of health problems.

"I have seen many patients who came to see me for ED declaring that they are in perfect health, only for me to diagnose them with diabetes and sometimes even high blood pressure and high cholesterol - the classic three highs," said Dr Tan.

What are some of the comorbidities of diabetes?

Diabetes affects every single organ of the body. Comorbidities include heart disease, high blood pressure, obesity, high cholesterol, cancer, obstructive sleep apnea, kidney failure, stroke, depression, numbness in finger and toes and ED.

Is diabetes a risk factor for ED?

It goes both ways. Patients with diabetes invariably develop ED. Also, ED may be the first presenting sign of diabetes.

Diabetes damages blood vessels. The blood vessels in the penis are much smaller than the blood vessels in the brain or the heart.

Therefore, the blood flow in a damaged blood vessel in the penis is much more severely affected as compared to that in the heart or brain.

This also means a patient with diabetes will suffer from ED before he gets a heart attack or a stroke. ED is therefore known as a warning sign for a heart attack in patients with diabetes.

Can male diabetic patients with comorbidities self-medicate for ED?

The most important thing for them to do is to see a doctor and get proper medical advice and treatment.

Unfortunately, many patients are still resistant to seeing a doctor for this. They end up taking all sorts of supplements or worse, self medicating with medicines bought over the Internet or from illegal and unofficial sources.

This can be potentially very harmful and even fatal.

Is there any drug that diabetic patients with ED should avoid?

The only drug that interacts severely with ED medicines are a class of drugs called nitrates.

Nitrates are frequently prescribed to patients with heart disease.

If a patient is on nitrates, he cannot take ED medicines.

Also, if a patient is given ED medicines, they must make this known to the doctors treating them. In case their doctor wants to prescribe them nitrates, they must be warned to stop taking the ED medicines.

Treating ED has to be a holistic approach. Many issues such as drug side effects, blood sugar control, and screening for heart disease have to be taken into account.

It is not as simple as "Here, take a Viagra when you want to have sex". Therefore, seeing a doctor is so important.