ETIOPATHOGENESIS AND MANAGEMENT OF IMPOTENCE IN DIABETIC MALES - 4 YEARS EXPERIENCE FROM A COMBINED CLINIC

The contribution of organic and psychogenic factors in the aetiopathogenesis of impotence was studied in a large number of diabetic males, to develop an algorithm for its management. We examined 110 consecutive patients who were refereed to the Impotence Clinic of the Diabetes Centre. All patients were initially evaluated by a diabetologist and then underwent psychosexual assessment by a specialized psychiatrist. Patients with primarily organic disease were referred to a urologist for further management while those with psychogenic impotence received psychosexual counselling. Peripheral neuropathy was present in 71 (65 %) and two or more autonomic tests were abnormal in 22 (20 %) patients. Neuropathy was the only cause detected in 29 (27 %) patients, the main cause in 22 (20 %), and contributing, but not the main factor, in 20 (18 %). Psychogenic factors were the only cause detected in 12 (11 %) patients, the main cause in 26 (24 %) and contributed in 19 (17 %). Marital disharmony, medical treatment, and peripheral vascular disease were the main aetiopathogenic factors in the remaining cases. Psychosexual counselling resulted in successful intercourse in 17 (60 %) out of the 24 treated patients and papaverine injections in 31 (61 %) out of 56 treated patients. It is concluded that although organic factors are mainly responsible for the development of impotence in diabetic males, psychological factors contribute significantly and psychosexual assessment and counselling are essential adjuncts to its management. Treatment with papaverine injections is generally inexpensive and effective to overcome the multifactorial causes of erectile dysfunction in this population. An algorithm which may facilitate the investigation and treatment of impotent diabetic males is proposed.