A New Era for Impotence?

Viagra Sheds Light on Erectile Dysfunction and Diabetes

| Oct 1, 1998

This story is intended for adult readers.

This complication generally affects those with a long history of diabetes.

In 1996, George Hutton was told by his doctor that he had type 1 diabetes. After suffering a stroke at the age of 56, Hutton also developed impotence. Instead of remaining silent, as more than 25 percent of men with diabetes do, Hutton chose to get help.

"I went to the doctor, willing to try anything," says Hutton. "It was embarrassing, but I had to do it."

This was long before Viagra had swept the market, making impotence a household topic and the punch line of innumerable jokes. At the time, Hutton was more the exception than the rule.

Dr. Bashar Omarbasha, medical director of the Male Sexual Dysfunction Center in Oneida, New York, has watched Viagra shed light on the hidden world of male sexual dysfunction. In effect, it has caused male impotence to "come out of the closet."

Many men, however, do not seek the help they need.

"The majority of the men we see at the clinic have had impotence for three to seven years before they come to us," says Omarbesha. "The longer a man waits to get help, the more serious his impotence can become. The earlier we see him the better."

Omarbesha explains that men will respond to minimally invasive treatments like pills or injections.

"If a patient waits too long, his only option may be an expensive implant," said Omarbesha. "This involves surgically implanting a prosthesis in the penis, and it can cost up to $8,000."

What Exactly is Impotence?

Many experts argue that the term "impotence" is misleading. It implies that a man suffers from a complete loss of sexuality. This is not the case. Erectile dysfunction is a more appropriate term since it refers specifically to erection problems. Most men with erectile dysfunction still have sexual desires, and are capable of having orgasms. They cannot, however, maintain an erection long enough for satisfactory intercourse.

Erectile dysfunction often occurs in men with diabetes who have had a long history of poor blood sugar control. This causes peripheral neuropathy, which causes the artery that feeds blood to the penis to function improperly.

"The same thing that causes a man's feet to tingle will cause difficulty with the nerves and blood flow to the penis," says Dr. Eric Orzeck, a Houston endocrinologist and CDE who sees many patients that suffer from erectile dysfunction.

Orzeck describes the typical patient as a man in his 40s to 60s, who is overweight, sedentary and has had a long history of diabetes.

"Men using oral agents will tend to develop it more, because they've often had elevated blood sugars for a longer period of time then they'd care to admit," said Orzeck.

Dr. Omarbesha estimates that at least 85 percent of his patients with diabetes have organic-based (physical) erectile dysfunction, rather than psychologically-based. Erectile dysfunction, however, almost always has psychological ramifications.

Many experts cite the so-called "self-fulfilling prophecy of erectile dysfunction and diabetes" as a major cause of stress for men with diabetes. This refers to the trauma that a patient experiences upon learning from a doctor that they not only have a chronic disease, but also a 50 percent chance of developing erectile dysfunction as well.

Many men, like George Hutton, are so disturbed by the gloomy statistics on impotence that they lose confidence in their sexuality.

"It's pretty depressing when you hear that kind of statistic," says Hutton.

Erectile dysfunction can also be exacerbated by such stresses as family, job and poor relationship communication. Due in part to psychological concerns, most doctors ask that a man's sex partner be present to determine how to best treat the dysfunction.

"I always ask that the wife be present for these discussions," says Dr. Orzeck. "There's hardly anything else in medicine that we do that has such a direct impact on another human being."

If a doctor senses that there are deeper relationship-based conflicts leading to the erectile dysfunction, he will often refer the patient to a sex therapist.

Howard Rosenthal, a psychologist and MD, has worked as a certified sex therapist in Houston for over 20 years. Rosenthal has worked with numerous patients with diabetes who have had deeper relationship conflicts to resolve.

"The withholding of sex can sometimes be the result of unresolved anger against a sex partner," says Rosenthal, who also points out that Viagra is not an option for everyone.

"There are some couples that Viagra does not help. You give them Viagra, and basically you now have a couple with an erection and the same sexual problems."

Rosenthal first consults with the patient alone, and takes a complete sexual history. He will then decide if the person needs couples therapy or group therapy. He believes many avoid sex therapy because they think they will have to go for years to resolve their problems.

"Oftentimes, I can cure a very complicated case in six months," says Rosenthal.

Sex therapy may also be covered by insurance. To be referred to a sex therapist in your area, contact the American Association of Sexuality Educators, Counselors and Therapists (AASECT) at (804) 752-0026, or send a self-addressed, stamped envelope for a list of certified sex therapists in your city to:

AASECT, P.O. Box 1960, Ashland, VA 23005-1960.

Viagra-Not a Cure All

Just as there are a variety of causes for erectile dysfunction, there are also numerous treatments. For a man with diabetes and neuropathy, however, oral agents such as the much-touted Viagra may not work.

"In the patients I see, less than 50 percent of the men are helped by Viagra," says Orzeck.

Viagra increases blood flow to the penis, and compresses the veins so that there is no blood flow out. This process produces an erection. The problem with neuropathy, however, is that many men with diabetes cannot get blood flow to the penis in the first place.

"If there is no water entering the lake, it's not going to help by putting a dam at either end," says Orzeck.

Dr. Omarbesha tries to see the positive aspects of these Viagra failures.

"Many men are coming to get help for the first time, because there has been so much talk about Viagra," says Omarbesha. "When the Viagra fails, however, patients come back to the clinic to see what other types of therapy will work for them."

Viagra is also not an option for men taking nitrate-based drugs to control a heart condition. Combined, both Viagra and nitrates can drop blood pressure to a dangerously low level that can result in death. If a man suffers from neuropathy, or takes nitrates, the best remedy for erectile dysfunction is injectable medication such as MUSE or Caverject. Many, however, are adverse to the idea of injecting themselves in the penis.

"I could never see injecting myself like that," says George Hutton, who has been offered these injectable remedies by his doctor.

"Men don't want to stick a needle in either the side of their penis, or a pellet into the tip of it," says Orzeck.

If a man can get over the fear, however, Orzeck says the injections can produce good results.

Vivus, the makers of MUSE, have reported a 60 percent success rate in men with diabetes. However, proper care and treatment of the diabetes are also critical elements in achieving this success rate. In many cases, proper maintenance of blood sugar is essential.

"Once men see that diabetes control has a direct relation to their sexual functioning, they start taking better care of their diabetes," says Omarbesha.

Most experts agree that diabetes and old age do not have to be a direct route to impotence.

"There is this myth that after you reach 60 or 70 your sexual ability and drive will drop to zero," says Orzeck. "This could not be further from the truth. It should persist as long as somebody wants it to persist."

Fortunately, since Viagra hit the market, more and more men are getting the help they should have gotten years ago. George Hutton, for one, is glad that some of the stigma surrounding erectile dysfunction has disappeared.

"Since Viagra, people are talking about impotence openly for the first time."

Dr. Orzeck has also noticed this new awareness.

"There is much more openness and discussion about male impotence these days," says Orzeck. "It isn't something that you need to be ashamed of anymore."

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