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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35807
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have diabetes (type 2), neuropathy, and parkinsons. I also

Resolved Question:

I have diabetes (type 2), neuropathy, and parkinsons. I also suffer from impotence. Are any or all of the symtoms I have, a cause of the impotence?
Submitted: 6 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 6 years ago.


Yes. Diabetes is one of the commonest risk factors associated with erectile dysfunction (ED) / impotence. The prevalence of ED is greater in men with diabetes compared with non diabetic population. Many factors can contribute to the development of ED, including organic factors (like vascular disease and neurological disease like neuropathy) and psychogenic factors (anxiety or depression). One of the most common risk factors associated with ED is diabetes. The pathophysiology of ED in men with diabetes is complex, but probably involves vascular and neurogenic components, together with endothelial dysfunction. Associated with the diabetes is a condition, which is called as subclinical late-onset hypogonadism (SLOH) which is suppose to cause erectile dysfunctions. In this there are two hormonal criteria;

1) measurement of testosterone concentration
2) Testosterone / LH ratio (T/LH)

In patients with decrease T/LH ratio, consideration of testosterone replacement therapy should be done, as studies have shown benefit. Apart from Testosterone levels and LH estimation, following also are advised;

1) Thyroid function tests
2) duplex ultrasonography
3) Ultrasonography of testes
4) angiography

For the management of the erectile dysfunctions, one needs to go in step wise fashion, as following;

1) The first step; Oral PDE-5 inhibitors remain the first-line therapy for the treatment of ED in men with no contraindications to their use. The medications are, sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). Efficacy has been demonstrated for general population as well as special populations, like men with diabetes mellitus, spinal cord injury, post-radical prostatectomy, multiple sclerosis, post-radiation therapy for prostate cancer, and depression. If you take oral nitrates (which is taken in angina, an heart disease), these medicines should not be taken.


2) The second step;
a) intraurethral suppositories,
b) the vacuum device, and
c) intracavernous injection.


3) Third step; Placement of a penile prosthesis is the primary therapeutic option for individuals who have failed or cannot tolerate prior therapies. This is a surgical option. There are two and three-piece inflatable prostheses.

4) Combination therapies;
a) Sildenafil Plus Intraurethral Prostaglandin E1
b) Oral PDE-5 Inhibitors Plus Intracavernous Injection of Prostaglandin E1
c) Sildenafil Combined with an Oral Alpha-Antagonist
d) Intracavernous Prostaglandin E1 Combined with Oral Alpha-Antagonist
e) Vacuum device and intracavernous injection therapy
f) Testosterone Plus Sildenafil

So out of these, certainly some will help you.

Please feel free for your follow up questions.

I would be happy to assist your further, if you need any more information.

Dr. Arun

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