Erectile Dysfunction: Most Effective Supplements

Erectile dysfunction, or erectile disorder, is defined as the persistent inability of a man to achieve or maintain an erection sufficient to allow satisfactory sexual intercourse. This phenomenon, although common, can be a source of distress for individuals who experience it. The prevalence of erectile dysfunction is particularly high among diabetic patients. Approximately 30% of men with type 1 diabetes and up to 46% of type 2 diabetics suffer from it. Studies, including the Massachusetts Male Aging Study (MMAS), show that the prevalence of erectile dysfunction is three times higher in diabetic individuals than in those without diabetes. This risk increases with age, duration of diabetes, poor glycemic control, as well as the presence of degenerative complications such as retinopathy or nephropathy.

Pathophysiology

Erectile dysfunction in diabetic patients is multifactorial and involves vascular, neurological, hormonal, and psychological mechanisms. Chronic hyperglycemia in these patients leads to an increased production of advanced glycation end-products (AGE), altering the elasticity of blood vessels and promoting atherosclerosis. Diabetic neuropathy, which affects somatic and autonomic nerves, disrupts the sacral reflex arc, essential for erection. Another factor is the decreased production of nitric oxide (NO), a molecule essential for the relaxation of the cavernous smooth muscle, making it difficult to achieve an erection. In parallel, psychological factors such as depression and anxiety can worsen the condition.

Biochemical Mechanisms of Erection

The erection of the penis is a complex process involving the central and peripheral nervous systems, as well as hormonal and vascular factors. Sexual stimulation triggers excitation signals in the brain, leading to the release of nitric oxide (NO) at the level of the parasympathetic nerves and endothelial cells of the penis. NO acts as a chemical messenger, activating guanylate cyclase, an enzyme that transforms guanosine triphosphate (GTP) into cyclic guanosine monophosphate (cGMP). This conversion causes the relaxation of the penile arteries’ smooth muscles and increases blood inflow into the penis. The engorgement of blood compresses the veins that normally drain the blood, trapping it in the cavernous bodies and thus producing an erection. The erection ends when cGMP is degraded by the enzyme phosphodiesterase type 5, which is why inhibitors of this enzyme, such as sildenafil (Viagra®), are effective in prolonging erection.

Etiologies

The causes of erectile dysfunction are varied. Diabetes is one of the main ones, involving vascular, neurological, and hormonal dysfunctions. Cardiovascular diseases, hypertension, and dyslipidemia are also strongly correlated with this disorder, as they affect vascular function. Psychological factors, such as depression or anxiety, can also play an important role in the onset of the disorder.

Treatment

The management of erectile dysfunction is based on a multidisciplinary approach, including medical treatments and psychological interventions: • Phosphodiesterase type 5 inhibitors (PDE5 inhibitors): These are the first-line treatments, with proven efficacy in diabetic patients. Medications like sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®) improve erectile function by increasing intracellular cGMP levels. • Intracavernosal injections: Injections of prostaglandin E1 are effective in inducing sufficient erections in diabetic patients, even in the absence of sexual stimulation. • Mechanical devices: Vacuum erection devices can be used, but their acceptability is often limited due to discomfort and aesthetic aspects. • Penile prostheses: For cases refractory to medical treatments, the implantation of penile prostheses offers an effective and lasting solution. To reduce the risk of erectile dysfunction, it is advisable to maintain good lifestyle habits. This includes measures such as quitting smoking, limiting alcohol consumption, weight management, and regular physical activity. Adopting a healthy lifestyle also helps limit other risk factors, such as vascular, hormonal, or neurological disorders, often involved in this condition. Stress management, quality sleep, and psychological support in cases of anxiety or depression also contribute to preserving erectile function.