Abstract
Background: Erectile dysfunctions in diabetes are important signs probably due to pelvic autonomic neuropathy with damage to the parasympathetic nervierignetes. Direct evidence for a neuropathic etiology comes from studies that show structural changes in autonomic nerve fibers supplying the corpora cavernosa.
The present study deals with the post ejaculatory effects of sildenafil citrate (Viagra) administration on sexual dysfunctions associated with diabetic neuropathy/erectile impotence prevailing in the male population.
Aim: To investigate whether sildenafil citrate administration maintains improved erectile functions in diabetic men with established autonomic neuropathy during post ejaculatory refractory phase (the phase of re-obtaining erection after ejaculation) after psychic and physical sexual stimulation. These findings may be of patho-physiological significance for the use of sildenafil citrate on the management of erectile dysfunctions in diabetic neuropathic men.
Methods: The study design consisted of a prospective cross-over, two period investigation (Pre and post ejaculation before and after the intake of 50 mg Viagra). Eectile/sexual functions including libido, erection frquency, masturbation ability, pattern of ejaculation, and pattern of erection lost were noted during audiovisual sexual stimulation in 50 insulin dependent diabetes mellitus (IDDM) and in 50 non insulin dependent diabetes mellitus (NIDDM) patients with and without an objective evidence of neuropathy, having an age span in between 20 and 65 years and a duration of diabetes distributed over 1-25 years with their age matched non diabetic controls.
Results: Sildenafil treatment showed a significant improvement (P<0.0005 in some cases) in all the parameters during the first ejaculatory phase in both types of diabetic neuropathics and were found to be maintained (absolute) during post-ejaculatory phase as well. However, this difference was found to be non significant in both types of diabetic patients without neuropathy and when compared with their respective control subjects during the first ejaculatory phase. A complete failure in the pattern of erotic responses in these subjects during the post ejaculatory phase was also observed since no erection/ejaculation could be achieved during this phase.
Conclusion: These results suggest that sildenafil citrate is an effective and well-tolerated treatment for erectile/sexual dysfunction in patients with diabetic neuropathy and has a positive influence over the resumption of erections and sexual functions following post ejaculation in the presence of a continuous psycho-sexual stimulus and adds a new aspect of interest in the research area concerning the regulatory mechanism of male copulatory behaviour.