Erectile dysfunction: the most effective dietary supplements

Erectile dysfunction, or erection disorder, is defined as the persistent inability of a man to obtain or maintain an erection sufficient to permit satisfactory sexual intercourse. This phenomenon, although common, can be a source of distress for affected individuals. The prevalence of erectile dysfunction is particularly high among diabetic patients. Approximately 30% of men with type 1 diabetes and up to 46% of those with type 2 diabetes suffer from it. Studies, notably the Massachusetts Male Aging Study (MMAS), show that the prevalence of erectile dysfunction is three times higher in people with diabetes than in those without. This risk increases with age, duration of diabetes, poor glycemic control, and 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 increased production of advanced glycation end products (AGEs), impairing 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 relaxation of the cavernosal smooth muscle, making it difficult to achieve an erection. At the same time, psychological factors such as depression and anxiety can worsen the disorder.

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 excitatory signals in the brain, which lead to the release of nitric oxide (NO) from parasympathetic nerves and endothelial cells of the penis. NO acts as a chemical messenger, activating guanylate cyclase, an enzyme that converts guanosine triphosphate (GTP) into cyclic guanosine monophosphate (cGMP). This conversion causes relaxation of the smooth muscles of the penile arteries and increases blood inflow into the penis. The engorgement of blood compresses the veins that normally drain blood, trapping blood in the corpora cavernosa and thus producing an erection. The erection ends when cGMP is degraded by the phosphodiesterase type 5 enzyme, which is why inhibitors of this enzyme, such as sildenafil (Viagra®), are effective at prolonging the erection.

Causes

The causes of erectile dysfunction are varied. Diabetes is one of the main causes, involving vascular, neurological, and hormonal dysfunctions. Cardiovascular disease, 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 condition.

Treatment

Management of erectile dysfunction is based on a multidisciplinary approach, including medical treatments and psychological interventions: • Phosphodiesterase type 5 inhibitors (PDE5 inhibitors): These are first-line treatments, with proven efficacy in diabetic patients. Drugs such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®) improve erectile function by increasing intracellular cGMP levels. • Intracavernosal injections: Prostaglandin E1 injections are effective at 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 cosmetic concerns. • Penile prostheses: For cases refractory to medical treatments, implantation of penile prostheses offers an effective and durable solution. To reduce the risk of erectile dysfunction, it is advisable to maintain a healthy lifestyle. This includes measures such as quitting smoking, limiting alcohol consumption, managing weight, and engaging in 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, good-quality sleep, and psychological support in cases of anxiety or depression also help preserve erectile function.